Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $33.88 / $38.02	Facility	26	$19.95	$33.88	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $40.74 / $112.20	Professional		$18.20	$40.74	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $17.78 / $51.29	Professional	26	$7.41	$17.78	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $23.99 / $57.54	Professional	TC	$10.00	$23.99	$57.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $67.61 / $120.23	Professional		$23.44	$67.61	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $23.99 / $42.66	Professional	26	$9.33	$23.99	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $45.71 / $81.28	Professional	TC	$15.49	$45.71	$81.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $93.33 / $114.82	Professional		$83.18	$93.33	$114.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $31.62 / $38.90	Professional	26	$27.54	$31.62	$38.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $61.66 / $77.62	Professional	TC	$54.95	$61.66	$77.62
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $30.20 / $38.02	Facility	26	$12.88	$30.20	$38.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $77.62 / $120.23	Professional		$29.51	$77.62	$120.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $29.51 / $44.67	Professional	26	$12.88	$29.51	$44.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $54.95 / $77.62	Professional	TC	$20.42	$54.95	$77.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $24.55 / $30.20	Facility	26	$13.18	$24.55	$30.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $16.22 / $17.38	Professional		$16.22	$16.22	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.79 / $29.51	Professional	26	$9.55	$14.79	$29.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $11.48 / $17.78 / $51.29	Professional	TC	$11.48	$17.78	$51.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.72 / $17.38 / $24.55	Facility	26	$3.72	$17.38	$24.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $79.43 / $120.23	Professional		$29.51	$79.43	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $22.91 / $43.65	Professional	26	$12.30	$22.91	$43.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $42.66 / $81.28	Professional	TC	$15.49	$42.66	$81.28
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Facility	26	$1,621.81	$1,621.81	$1,621.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $81.28 / $109.65	Professional		$33.88	$81.28	$109.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $28.84 / $40.74	Professional	26	$14.79	$28.84	$40.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $51.29 / $70.79	Professional	TC	$17.38	$51.29	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $43.65 / $112.20	Professional		$16.98	$43.65	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $16.22 / $39.81	Professional	26	$8.32	$16.22	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $27.54 / $72.44	Professional	TC	$10.23	$27.54	$72.44