Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $25.70 / $52.48	Professional		$21.88	$25.70	$52.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $20.89 / $25.70	Professional	26	$18.20	$20.89	$25.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $3.02 / $3.98 / $25.70	Professional	TC	$3.02	$3.98	$25.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $43.65 / $74.13	Professional		$25.12	$43.65	$74.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $32.36 / $57.54	Professional	26	$20.89	$32.36	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $4.07 / $8.91 / $25.70	Professional	TC	$4.07	$8.91	$25.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $52.48 / $63.10	Professional		$25.70	$52.48	$63.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $43.65 / $51.29	Professional	26	$21.38	$43.65	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $4.68 / $9.12 / $11.48	Professional	TC	$4.68	$9.12	$11.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $43.65 / $66.07	Professional		$30.20	$43.65	$66.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $35.48 / $50.12	Professional	26	$23.99	$35.48	$50.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.90 / $7.76 / $44.67	Professional	TC	$4.90	$7.76	$44.67
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $39.81 / $41.69	Facility	26	$33.88	$39.81	$41.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $33.88 / $43.65	Professional	26	$23.99	$33.88	$43.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $4.79 / $8.32 / $50.12	Professional	TC	$4.79	$8.32	$50.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $48.98 / $79.43	Professional		$30.20	$48.98	$79.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $38.02 / $58.88	Professional	26	$23.99	$38.02	$58.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $4.57 / $10.23 / $50.12	Professional	TC	$4.57	$10.23	$50.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $50.12 / $67.61	Professional		$28.84	$50.12	$67.61
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $41.69 / $54.95	Professional	26	$23.99	$41.69	$54.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $4.79 / $8.71 / $11.48	Professional	TC	$4.79	$8.71	$11.48
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $43.65 / $79.43	Professional		$26.30	$43.65	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.88 / $53.70	Professional	26	$21.38	$33.88	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $2.95 / $7.24 / $44.67	Professional	TC	$2.95	$7.24	$44.67