Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.05 / $29.25 / $65.64	Facility	26	$18.05	$29.25	$65.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.85 / $54.12 / $178.63	Professional		$34.85	$54.12	$178.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.98 / $50.77	Professional	26	$12.59	$17.98	$50.77
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.70 / $23.64 / $61.28	Professional	52	$14.70	$23.64	$61.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $31.84 / $70.78	Professional	TC	$22.26	$31.84	$70.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.96 / $14.96 / $14.96	Facility	26	$14.96	$14.96	$14.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.01 / $78.56 / $125.13	Professional		$41.01	$78.56	$125.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.53 / $26.73 / $39.47	Professional	26	$15.53	$26.73	$39.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.86 / $54.25 / $91.05	Professional	TC	$26.86	$54.25	$91.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.40 / $106.32 / $122.96	Professional		$89.40	$106.32	$122.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $29.72 / $33.47	Professional	26	$24.78	$29.72	$33.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.86 / $76.25 / $89.49	Professional	TC	$63.86	$76.25	$89.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $59.36 / $76.98 / $137.25	Professional		$59.36	$76.98	$137.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.82 / $27.07 / $39.65	Professional	26	$20.82	$27.07	$39.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.78 / $69.44 / $97.59	Professional	TC	$51.78	$69.44	$97.59
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.09 / $25.55 / $27.47	Facility	26	$20.09	$25.55	$27.47
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.77 / $23.71 / $29.04	Professional	26	$16.77	$23.71	$29.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $38.40 / $56.95	Professional	TC	$28.14	$38.40	$56.95
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.96 / $14.96 / $14.96	Facility	26	$14.96	$14.96	$14.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $62.22 / $92.81 / $128.25	Professional		$62.22	$92.81	$128.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.67 / $27.18 / $39.47	Professional	26	$17.67	$27.18	$39.47
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $49.70 / $52.27 / $52.27	Professional	52	$49.70	$52.27	$52.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.82 / $62.76 / $91.08	Professional	TC	$32.82	$62.76	$91.08
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $70.76 / $93.16 / $123.68	Professional		$70.76	$93.16	$123.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $28.88 / $36.95	Professional	26	$23.34	$28.88	$36.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.90 / $65.28 / $87.56	Professional	TC	$44.90	$65.28	$87.56
United Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $45.75 / $127.96	Professional		$36.65	$45.75	$127.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $17.30 / $40.29	Professional	26	$14.07	$17.30	$40.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.25 / $42.78 / $87.87	Professional	TC	$22.25	$42.78	$87.87