Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $23.44 / $29.51	Facility	26	$14.79	$23.44	$29.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $45.71 / $134.90	Professional		$31.62	$45.71	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $14.79 / $37.15	Professional	26	$8.13	$14.79	$37.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $70.79	Professional	TC	$21.88	$31.62	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $72.44 / $112.20	Professional		$35.48	$72.44	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $19.50 / $30.20	Professional	26	$10.00	$19.50	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $52.48 / $83.18	Professional	TC	$25.12	$52.48	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $85.11 / $107.15	Professional		$74.13	$85.11	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $27.54	Professional	26	$19.50	$22.91	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $61.66 / $79.43	Professional	TC	$54.95	$61.66	$79.43
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.38 / $29.51	Facility	26	$14.79	$21.38	$29.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $67.61 / $109.65	Professional		$41.69	$67.61	$109.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $19.95 / $32.36	Professional	26	$10.47	$19.95	$32.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $54.95 / $85.11	Professional	TC	$29.51	$54.95	$85.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $19.50 / $21.88	Facility	26	$15.49	$19.50	$21.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $20.89	Professional	26	$10.96	$16.22	$20.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $42.66 / $51.29	Professional	TC	$29.51	$42.66	$51.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $77.62 / $112.20	Professional		$58.88	$77.62	$112.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $30.20	Professional	26	$13.80	$19.50	$30.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $53.70 / $83.18	Professional	TC	$35.48	$53.70	$83.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $77.62 / $104.71	Professional		$63.10	$77.62	$104.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $21.38 / $28.84	Professional	26	$16.60	$21.38	$28.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $57.54 / $75.86	Professional	TC	$44.67	$57.54	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $44.67 / $102.33	Professional		$33.11	$44.67	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.59 / $28.84	Professional	26	$9.77	$12.59	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $74.13	Professional	TC	$23.44	$31.62	$74.13