Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.01 / $75.81 / $79.14	Facility	26	$5.01	$75.81	$79.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.92 / $41.98 / $135.06	Professional		$25.92	$41.98	$135.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.08 / $4.38 / $15.44	Professional	26	$3.08	$4.38	$15.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.14 / $17.00 / $44.71	Professional	52	$10.14	$17.00	$44.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.78 / $34.18 / $90.00	Professional	TC	$22.78	$34.18	$90.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.90 / $54.19 / $94.40	Professional		$32.90	$54.19	$94.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $4.13 / $6.58 / $9.56	Professional	26	$4.13	$6.58	$9.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.88 / $47.51 / $81.68	Professional	TC	$28.88	$47.51	$81.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $50.86 / $62.47	Professional		$43.65	$50.86	$62.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $5.72 / $6.79 / $7.81	Professional	26	$5.72	$6.79	$7.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $37.82 / $44.25 / $54.65	Professional	TC	$37.82	$44.25	$54.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $34.50 / $44.02 / $72.16	Professional		$34.50	$44.02	$72.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $4.80 / $6.38 / $9.53	Professional	26	$4.80	$6.38	$9.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.48 / $42.34 / $62.58	Professional	TC	$31.48	$42.34	$62.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $4.41 / $6.01 / $7.08	Facility	26	$4.41	$6.01	$7.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $3.62 / $5.50 / $7.37	Professional	26	$3.62	$5.50	$7.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.33 / $38.97 / $67.00	Professional	TC	$25.33	$38.97	$67.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.28 / $53.97 / $70.81	Professional		$42.28	$53.97	$70.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $4.13 / $6.68 / $9.11	Professional	26	$4.13	$6.68	$9.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.09 / $46.33 / $65.84	Professional	TC	$28.09	$46.33	$65.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $44.33 / $54.64 / $67.14	Professional		$44.33	$54.64	$67.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $5.70 / $7.02 / $8.52	Professional	26	$5.70	$7.02	$8.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.63 / $47.61 / $58.85	Professional	TC	$38.63	$47.61	$58.85
United Facility/Professional Professional Modifier Low / Median / High Price $30.02 / $51.45 / $77.45	Professional		$30.02	$51.45	$77.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.93 / $6.51 / $9.58	Professional	26	$3.93	$6.51	$9.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.76 / $42.69 / $67.48	Professional	TC	$24.76	$42.69	$67.48