Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $24.55 / $54.95	Facility	26	$14.13	$24.55	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $43.65 / $169.82	Professional		$29.51	$43.65	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $61.66	Professional	26	$10.00	$15.14	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $23.99 / $43.65	Professional	TC	$18.20	$23.99	$43.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $97.72	Professional		$38.02	$61.66	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $20.89 / $34.67	Professional	26	$14.79	$20.89	$34.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $39.81 / $66.07	Professional	TC	$23.44	$39.81	$66.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $72.44 / $85.11	Professional		$64.57	$72.44	$85.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $23.44 / $26.92	Professional	26	$21.38	$23.44	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $48.98 / $57.54	Professional	TC	$42.66	$48.98	$57.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $17.38 / $54.95	Facility	26	$17.38	$17.38	$54.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $69.18 / $91.20	Professional		$38.90	$69.18	$91.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $22.39 / $33.88	Professional	26	$14.13	$22.39	$33.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $45.71 / $63.10	Professional	TC	$23.99	$45.71	$63.10
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $20.42 / $26.30	Facility	26	$16.98	$20.42	$26.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $18.20 / $26.30	Professional	26	$13.49	$18.20	$26.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $35.48 / $46.77	Professional	TC	$28.84	$35.48	$46.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.51 / $11.75 / $16.98	Facility	26	$2.51	$11.75	$16.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $70.79 / $93.33	Professional		$52.48	$70.79	$93.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $25.70 / $34.67	Professional	26	$16.22	$25.70	$34.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $45.71 / $66.07	Professional	TC	$29.51	$45.71	$66.07
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $91.20	Professional		$50.12	$66.07	$91.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $24.55 / $32.36	Professional	26	$17.78	$24.55	$32.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $42.66 / $58.88	Professional	TC	$32.36	$42.66	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $67.61 / $97.72	Professional		$38.02	$67.61	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $26.30 / $36.31	Professional	26	$14.45	$26.30	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $42.66 / $63.10	Professional	TC	$23.44	$42.66	$63.10