Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $23.44 / $25.12	Facility	26	$15.14	$23.44	$25.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $56.23 / $295.12	Professional		$21.88	$56.23	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.59 / $54.95	Professional	26	$8.91	$12.59	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $30.90 / $120.23	Professional	TC	$12.88	$30.90	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $56.23 / $144.54	Professional		$28.84	$56.23	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $17.78 / $27.54	Professional	26	$10.47	$17.78	$27.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $35.48 / $128.82	Professional	TC	$17.78	$35.48	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $54.95 / $69.18	Professional		$48.98	$54.95	$69.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $19.95 / $23.99	Professional	26	$17.78	$19.95	$23.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $44.67	Professional	TC	$28.18	$34.67	$44.67
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $25.12 / $104.71	Facility	26	$21.88	$25.12	$104.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $123.03	Professional		$40.74	$56.23	$123.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.50 / $29.51	Professional	26	$10.96	$19.50	$29.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $34.67 / $109.65	Professional	TC	$20.89	$34.67	$109.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $18.62 / $19.05	Facility	26	$15.49	$18.62	$19.05
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $16.98 / $20.89	Professional	26	$11.22	$16.98	$20.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $27.54 / $102.33	Professional	TC	$16.22	$27.54	$102.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.29 / $10.72 / $15.14	Facility	26	$2.29	$10.72	$15.14
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $3.09 / $5.13 / $7.94	Facility	53	$3.09	$5.13	$7.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $117.49	Professional		$39.81	$53.70	$117.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.95 / $27.54	Professional	26	$13.18	$19.95	$27.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $120.23	Professional	TC	$21.88	$34.67	$120.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $50.12 / $72.44	Professional		$40.74	$50.12	$72.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $19.95 / $25.70	Professional	26	$16.98	$19.95	$25.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $29.51 / $44.67	Professional	TC	$23.44	$29.51	$44.67
United Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $44.67 / $95.50	Professional		$19.95	$44.67	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $12.59 / $28.18	Professional	26	$8.51	$12.59	$28.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $25.12 / $79.43	Professional	TC	$11.22	$25.12	$79.43