Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $20.89 / $25.12	Facility	26	$14.79	$20.89	$25.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $38.90 / $85.11	Professional		$22.91	$38.90	$85.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.72 / $23.44	Professional	26	$7.08	$10.72	$23.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.67 / $56.23 / $93.33	Professional	52	$44.67	$56.23	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $28.18 / $52.48	Professional	TC	$15.14	$28.18	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $61.66 / $95.50	Professional		$36.31	$61.66	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.20 / $28.84	Professional	26	$10.96	$18.20	$28.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $69.18	Professional	TC	$25.70	$43.65	$69.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $66.07 / $79.43	Professional		$58.88	$66.07	$79.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $19.95 / $23.44	Professional	26	$17.78	$19.95	$23.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $45.71 / $56.23	Professional	TC	$40.74	$45.71	$56.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $20.89 / $25.12	Facility	26	$20.89	$20.89	$25.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $61.66 / $85.11	Professional		$41.69	$61.66	$85.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $19.05 / $26.92	Professional	26	$10.72	$19.05	$26.92
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $44.67 / $56.23 / $93.33	Professional	52	$44.67	$56.23	$93.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $43.65 / $57.54	Professional	TC	$25.12	$43.65	$57.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $17.78 / $19.95	Facility	26	$14.79	$17.78	$19.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $18.20 / $21.88	Professional	26	$12.02	$18.20	$21.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $40.74 / $54.95	Professional	TC	$28.84	$40.74	$54.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $67.61 / $89.13	Professional		$50.12	$67.61	$89.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $20.89 / $27.54	Professional	26	$13.18	$20.89	$27.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $47.86 / $67.61	Professional	TC	$31.62	$47.86	$67.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $85.11	Professional		$51.29	$67.61	$85.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $20.42 / $24.55	Professional	26	$16.22	$20.42	$24.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $46.77 / $58.88	Professional	TC	$35.48	$46.77	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $41.69 / $89.13	Professional		$31.62	$41.69	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.02 / $26.92	Professional	26	$9.77	$12.02	$26.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $28.84 / $61.66	Professional	TC	$21.88	$28.84	$61.66