Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.69 / $16.66 / $35.86	Facility	26	$10.69	$16.66	$35.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.71 / $39.47 / $115.57	Professional		$18.71	$39.47	$115.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $10.63 / $35.67	Professional	26	$7.03	$10.63	$35.67
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.36 / $15.24 / $38.75	Professional	52	$9.36	$15.24	$38.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.17 / $23.41 / $57.37	Professional	TC	$17.17	$23.41	$57.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.90 / $53.51 / $79.22	Professional		$28.90	$53.51	$79.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $15.02 / $22.17	Professional	26	$8.55	$15.02	$22.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.23 / $39.04 / $59.01	Professional	TC	$21.23	$39.04	$59.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.84 / $66.44 / $76.81	Professional		$55.84	$66.44	$76.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.67 / $17.55 / $19.76	Professional	26	$14.67	$17.55	$19.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $40.72 / $48.62 / $57.09	Professional	TC	$40.72	$48.62	$57.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $43.00 / $49.48 / $87.42	Professional		$43.00	$49.48	$87.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $15.03 / $23.37	Professional	26	$12.28	$15.03	$23.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.00 / $41.43 / $64.05	Professional	TC	$33.00	$41.43	$64.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.27 / $14.95 / $15.41	Facility	26	$11.27	$14.95	$15.41
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.25 / $13.10 / $15.87	Professional	26	$9.25	$13.10	$15.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $21.71 / $32.33 / $39.65	Professional	TC	$21.71	$32.33	$39.65
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.84 / $61.71 / $81.83	Professional		$44.84	$61.71	$81.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $15.33 / $22.62	Professional	26	$10.42	$15.33	$22.62
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $31.63 / $33.29 / $33.29	Professional	52	$31.63	$33.29	$33.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.53 / $59.01	Professional	TC	$28.18	$41.53	$59.01
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 / $59.69 / $78.70	Professional		$51.47	$59.69	$78.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.77 / $16.27 / $21.79	Professional	26	$13.77	$16.27	$21.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $43.16 / $57.46	Professional	TC	$37.36	$43.16	$57.46
United Facility/Professional Professional Modifier Low / Median / High Price $26.95 / $37.06 / $80.89	Professional		$26.95	$37.06	$80.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.24 / $9.60 / $23.74	Professional	26	$8.24	$9.60	$23.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.69 / $25.16 / $57.88	Professional	TC	$18.69	$25.16	$57.88