Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.88 / $42.25 / $49.36	Facility	26	$34.88	$42.25	$49.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.95 / $42.06 / $144.91	Professional		$32.95	$42.06	$144.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.44 / $26.88 / $100.00	Professional	26	$21.44	$26.88	$100.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.24 / $18.96 / $44.76	Professional	52	$15.24	$18.96	$44.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.29 / $13.04 / $25.87	Professional	TC	$11.29	$13.04	$25.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.21 / $64.29 / $91.36	Professional		$37.21	$64.29	$91.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.56 / $42.67 / $59.79	Professional	26	$24.56	$42.67	$59.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.65 / $21.92 / $33.85	Professional	TC	$12.65	$21.92	$33.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.56 / $73.08 / $90.74	Professional		$64.56	$73.08	$90.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.72 / $46.28 / $55.04	Professional	26	$39.72	$46.28	$55.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.02 / $27.21 / $32.65	Professional	TC	$23.02	$27.21	$32.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.98 / $60.14 / $100.20	Professional		$44.98	$60.14	$100.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.44 / $40.38 / $66.09	Professional	26	$29.44	$40.38	$66.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.21 / $23.35 / $36.36	Professional	TC	$17.21	$23.35	$36.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.58 / $42.93 / $43.55	Facility	26	$28.58	$42.93	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.13 / $35.75 / $43.55	Professional	26	$26.13	$35.75	$43.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $15.08 / $22.82 / $24.79	Professional	TC	$15.08	$22.82	$24.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $70.31 / $89.81	Professional		$47.00	$70.31	$89.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.89 / $44.40 / $59.25	Professional	26	$24.89	$44.40	$59.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $13.25 / $23.75 / $33.85	Professional	TC	$13.25	$23.75	$33.85
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 $40.67 / $71.17 / $93.90	Professional		$40.67	$71.17	$93.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.44 / $46.48 / $61.59	Professional	26	$26.44	$46.48	$61.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $14.23 / $24.01 / $33.15	Professional	TC	$14.23	$24.01	$33.15
United Facility/Professional Professional Modifier Low / Median / High Price $46.56 / $64.61 / $97.29	Professional		$46.56	$64.61	$97.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.21 / $44.85 / $66.56	Professional	26	$31.21	$44.85	$66.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.00 / $21.01 / $32.36	Professional	TC	$15.00	$21.01	$32.36