Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.30 / $17.23 / $194.20	Facility	26	$11.30	$17.23	$194.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.75 / $67.56 / $256.77	Professional		$52.75	$67.56	$256.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.53 / $11.30 / $40.13	Professional	26	$7.53	$11.30	$40.13
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.47 / $31.77 / $77.41	Professional	52	$25.47	$31.77	$77.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.29 / $54.58 / $106.77	Professional	TC	$45.29	$54.58	$106.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.70 / $109.89 / $159.47	Professional		$61.70	$109.89	$159.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.64 / $16.95 / $24.15	Professional	26	$9.64	$16.95	$24.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.61 / $93.21 / $135.33	Professional	TC	$52.61	$93.21	$135.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.41 / $121.09 / $153.49	Professional		$107.41	$121.09	$153.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.46 / $21.96	Professional	26	$15.85	$18.46	$21.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $86.60 / $102.45 / $122.96	Professional	TC	$86.60	$102.45	$122.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.04 / $97.42 / $146.72	Professional		$79.04	$97.42	$146.72
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $16.14 / $26.43	Professional	26	$11.77	$16.14	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.30 / $88.19 / $145.38	Professional	TC	$64.30	$88.19	$145.38
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.60 / $17.12 / $17.42	Facility	26	$12.60	$17.12	$17.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.92 / $14.84 / $19.82	Professional	26	$10.92	$14.84	$19.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $53.76 / $79.20 / $102.18	Professional	TC	$53.76	$79.20	$102.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.37 / $119.77 / $155.44	Professional		$78.37	$119.77	$155.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $17.64 / $24.15	Professional	26	$9.94	$17.64	$24.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.23 / $96.43 / $135.33	Professional	TC	$54.23	$96.43	$135.33
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.25 / $120.28 / $160.13	Professional		$72.25	$120.28	$160.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.05 / $18.50 / $24.64	Professional	26	$11.05	$18.50	$24.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.20 / $101.77 / $135.49	Professional	TC	$61.20	$101.77	$135.49
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $108.12 / $164.33	Professional		$74.13	$108.12	$164.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $18.20 / $27.40	Professional	26	$12.48	$18.20	$27.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.00 / $90.71 / $137.63	Professional	TC	$64.00	$90.71	$137.63