Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.27 / $23.80 / $191.44	Facility	26	$15.27	$23.80	$191.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.63 / $65.30 / $256.00	Professional		$52.63	$65.30	$256.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $17.80 / $59.96	Professional	26	$11.24	$17.80	$59.96
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.03 / $31.78 / $76.05	Professional	52	$24.03	$31.78	$76.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.10 / $49.39 / $94.37	Professional	TC	$41.10	$49.39	$94.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.99 / $107.43 / $155.24	Professional		$60.99	$107.43	$155.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.31 / $23.00 / $32.50	Professional	26	$13.31	$23.00	$32.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.69 / $84.44 / $124.49	Professional	TC	$47.69	$84.44	$124.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $108.51 / $121.84 / $154.44	Professional		$108.51	$121.84	$154.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.41 / $24.94 / $29.66	Professional	26	$21.41	$24.94	$29.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.09 / $97.12 / $116.56	Professional	TC	$82.09	$97.12	$116.56
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.98 / $96.38 / $148.47	Professional		$76.98	$96.38	$148.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.51 / $35.58	Professional	26	$15.85	$21.51	$35.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.14 / $83.85 / $130.65	Professional	TC	$61.14	$83.85	$130.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.96 / $23.14 / $23.45	Facility	26	$16.96	$23.14	$23.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $19.25 / $24.67	Professional	26	$14.07	$19.25	$24.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.65 / $73.15 / $89.11	Professional	TC	$50.65	$73.15	$89.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $76.14 / $114.93 / $147.03	Professional		$76.14	$114.93	$147.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.65 / $23.88 / $32.50	Professional	26	$13.65	$23.88	$32.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.91 / $87.41 / $124.49	Professional	TC	$49.91	$87.41	$124.49
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $113.79 / $152.12	Professional		$71.40	$113.79	$152.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $24.94 / $33.15	Professional	26	$14.88	$24.94	$33.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.53 / $88.93 / $119.25	Professional	TC	$56.53	$88.93	$119.25
United Facility/Professional Professional Modifier Low / Median / High Price $74.00 / $107.22 / $165.36	Professional		$74.00	$107.22	$165.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.14 / $24.50 / $36.17	Professional	26	$17.14	$24.50	$36.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.01 / $81.20 / $119.73	Professional	TC	$58.01	$81.20	$119.73