Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.22 / $38.47 / $53.64	Professional		$27.22	$38.47	$53.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $27.13 / $34.86	Professional	26	$17.85	$27.13	$34.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.61 / $19.23 / $26.82	Professional	52	$13.61	$19.23	$26.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $4.09 / $5.70 / $31.75	Professional	TC	$4.09	$5.70	$31.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.42 / $57.57 / $82.31	Professional		$29.42	$57.57	$82.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.24 / $42.67 / $69.68	Professional	26	$24.24	$42.67	$69.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.45 / $9.26 / $15.18	Professional	TC	$3.45	$9.26	$15.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $29.02 / $61.22 / $69.22	Professional		$29.02	$61.22	$69.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.87 / $52.94 / $59.33	Professional	26	$24.87	$52.94	$59.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $4.15 / $8.31 / $9.90	Professional	TC	$4.15	$8.31	$9.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $33.94 / $46.97 / $74.02	Professional		$33.94	$46.97	$74.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $39.50 / $58.41	Professional	26	$26.81	$39.50	$58.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.34 / $6.79 / $13.05	Professional	TC	$4.34	$6.79	$13.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.94 / $40.47 / $48.91	Facility	26	$28.94	$40.47	$48.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $22.50 / $30.21 / $48.99	Professional	26	$22.50	$30.21	$48.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $3.65 / $8.03 / $41.50	Professional	TC	$3.65	$8.03	$41.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $34.36 / $55.73 / $82.31	Professional		$34.36	$55.73	$82.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.27 / $43.58 / $69.68	Professional	26	$24.27	$43.58	$69.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $3.45 / $9.26 / $15.18	Professional	TC	$3.45	$9.26	$15.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $33.22 / $54.45 / $80.56	Professional		$33.22	$54.45	$80.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.21 / $46.22 / $68.40	Professional	26	$28.21	$46.22	$68.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $5.03 / $8.23 / $12.18	Professional	TC	$5.03	$8.23	$12.18
United Facility/Professional Professional Modifier Low / Median / High Price $32.77 / $50.41 / $87.42	Professional		$32.77	$50.41	$87.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.45 / $41.04 / $73.72	Professional	26	$25.45	$41.04	$73.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.69 / $7.58 / $14.37	Professional	TC	$3.69	$7.58	$14.37