Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.59 / $20.39 / $45.74	Facility	26	$19.59	$20.39	$45.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.05 / $39.51 / $175.62	Professional		$23.05	$39.51	$175.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.44 / $12.45 / $28.21	Professional	26	$7.44	$12.45	$28.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.25 / $19.28 / $39.14	Professional	52	$9.25	$19.28	$39.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.61 / $28.39 / $78.95	Professional	TC	$15.61	$28.39	$78.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.58 / $63.52 / $96.18	Professional		$38.58	$63.52	$96.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.63 / $19.14 / $28.54	Professional	26	$11.63	$19.14	$28.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.88 / $45.97 / $67.64	Professional	TC	$26.88	$45.97	$67.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.19 / $67.97 / $78.54	Professional		$57.19	$67.97	$78.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $20.68 / $23.29	Professional	26	$17.23	$20.68	$23.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.42 / $47.07 / $55.22	Professional	TC	$39.42	$47.07	$55.22
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $46.43 / $60.76 / $87.42	Professional		$46.43	$60.76	$87.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $18.48 / $27.45	Professional	26	$14.40	$18.48	$27.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.03 / $45.61 / $59.97	Professional	TC	$32.03	$45.61	$59.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.70 / $17.78 / $20.10	Facility	26	$14.70	$17.78	$20.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $18.00 / $22.11	Professional	26	$12.14	$18.00	$22.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.40 / $40.79 / $54.52	Professional	TC	$29.40	$40.79	$54.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.61 / $68.26 / $85.71	Professional		$50.61	$68.26	$85.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $19.47 / $28.99	Professional	26	$12.23	$19.47	$28.99
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $32.90 / $32.90 / $32.90	Professional	52	$32.90	$32.90	$32.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.94 / $47.65 / $69.01	Professional	TC	$27.94	$47.65	$69.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $51.47 / $69.58 / $82.47	Professional		$51.47	$69.58	$82.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $20.48 / $25.58	Professional	26	$16.16	$20.48	$25.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.31 / $47.74 / $58.50	Professional	TC	$35.31	$47.74	$58.50
United Facility/Professional Professional Modifier Low / Median / High Price $31.76 / $44.92 / $90.82	Professional		$31.76	$44.92	$90.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.74 / $12.48 / $27.91	Professional	26	$9.74	$12.48	$27.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.02 / $29.85 / $62.48	Professional	TC	$22.02	$29.85	$62.48