Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.63 / $22.79 / $26.44	Facility	26	$18.63	$22.79	$26.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.06 / $115.56 / $421.00	Professional		$75.06	$115.56	$421.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.27 / $14.27 / $54.00	Professional	26	$11.27	$14.27	$54.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.87 / $56.24 / $229.70	Professional	52	$31.87	$56.24	$229.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.08 / $107.17 / $187.25	Professional	TC	$73.08	$107.17	$187.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.13 / $182.70 / $276.16	Professional		$111.13	$182.70	$276.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $24.54 / $36.11	Professional	26	$14.04	$24.54	$36.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.09 / $159.60 / $247.09	Professional	TC	$97.09	$159.60	$247.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $156.13 / $181.96 / $223.30	Professional		$156.13	$181.96	$223.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.60 / $25.62 / $29.49	Professional	26	$21.60	$25.62	$29.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.13 / $156.94 / $193.84	Professional	TC	$134.13	$156.94	$193.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $126.48 / $152.05 / $248.58	Professional		$126.48	$152.05	$248.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.68 / $23.10 / $37.13	Professional	26	$18.68	$23.10	$37.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.08 / $142.65 / $222.81	Professional	TC	$112.08	$142.65	$222.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.64 / $22.67 / $24.12	Facility	26	$17.64	$22.67	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $19.95 / $25.38	Professional	26	$14.47	$19.95	$25.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $86.43 / $132.94 / $170.51	Professional	TC	$86.43	$132.94	$170.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.90 / $186.98 / $239.38	Professional		$151.90	$186.98	$239.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $25.92 / $34.42	Professional	26	$15.96	$25.92	$34.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $99.65 / $162.80 / $218.92	Professional	TC	$99.65	$162.80	$218.92
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $155.76 / $192.78 / $233.09	Professional		$155.76	$192.78	$233.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.85 / $27.32 / $34.39	Professional	26	$21.85	$27.32	$34.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $132.97 / $165.47 / $198.98	Professional	TC	$132.97	$165.47	$198.98
United Facility/Professional Professional Modifier Low / Median / High Price $93.61 / $168.01 / $248.60	Professional		$93.61	$168.01	$248.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.93 / $25.20 / $39.96	Professional	26	$13.93	$25.20	$39.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.26 / $150.50 / $210.87	Professional	TC	$88.26	$150.50	$210.87