Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $29.45 / $36.93 / $57.72	Facility		$29.45	$36.93	$57.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.66 / $4.66 / $7.29	Facility	26	$4.66	$4.66	$7.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.50 / $30.45 / $59.98	Professional		$18.50	$30.45	$59.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.36 / $3.99 / $7.37	Professional	26	$2.36	$3.99	$7.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $7.84 / $14.51 / $31.78	Professional	52	$7.84	$14.51	$31.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.10 / $26.23 / $50.77	Professional	TC	$15.10	$26.23	$50.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.10 / $26.10	Facility		$26.10	$26.10	$26.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $3.41	Facility	26	$3.41	$3.41	$3.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.37 / $45.18 / $68.84	Professional		$28.37	$45.18	$68.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.96 / $6.16 / $9.88	Professional	26	$3.96	$6.16	$9.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.81 / $38.84 / $57.12	Professional	TC	$23.81	$38.84	$57.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $45.18 / $53.94 / $62.83	Professional		$45.18	$53.94	$62.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $6.76 / $7.61	Professional	26	$5.62	$6.76	$7.61
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 Facility Modifier Low / Median / High Price $19.62 / $41.80 / $66.00	Facility		$19.62	$41.80	$66.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $35.38 / $47.10 / $73.20	Professional		$35.38	$47.10	$73.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.80 / $6.84 / $18.60	Professional	26	$4.80	$6.84	$18.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.03 / $45.61 / $60.99	Professional	TC	$32.03	$45.61	$60.99
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $31.27 / $41.69 / $57.00	Facility		$31.27	$41.69	$57.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.41 / $5.76 / $7.48	Facility	26	$4.41	$5.76	$7.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $3.62 / $5.76 / $7.80	Professional	26	$3.62	$5.76	$7.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.38 / $33.50 / $45.90	Professional	TC	$22.38	$33.50	$45.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $19.72 / $45.95 / $64.56	Facility		$19.72	$45.95	$64.56
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $3.41	Facility	26	$3.41	$3.41	$3.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.81 / $50.05 / $67.09	Professional		$36.81	$50.05	$67.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $4.08 / $6.16 / $9.26	Professional	26	$4.08	$6.16	$9.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.73 / $39.54 / $57.12	Professional	TC	$26.73	$39.54	$57.12
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $150.13 / $177.46 / $229.07	Facility		$150.13	$177.46	$229.07
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $188.60 / $188.60 / $188.60	Facility	26	$188.60	$188.60	$188.60
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $36.58 / $48.65 / $62.78	Professional		$36.58	$48.65	$62.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.46 / $6.59 / $8.52	Professional	26	$5.46	$6.59	$8.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.56 / $42.30 / $54.59	Professional	TC	$31.56	$42.30	$54.59
United Facility/Professional Professional Modifier Low / Median / High Price $23.50 / $41.55 / $71.48	Professional		$23.50	$41.55	$71.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.25 / $6.22 / $9.58	Professional	26	$3.25	$6.22	$9.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $34.45 / $54.79	Professional	TC	$19.13	$34.45	$54.79