Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $19.95 / $194.98	Facility	26	$11.22	$19.95	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $67.61 / $263.03	Professional		$52.48	$67.61	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.22 / $38.02	Professional	26	$7.94	$11.22	$38.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $8.13 / $8.32 / $39.81	Professional	52	$8.13	$8.32	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $53.70 / $104.71	Professional	TC	$43.65	$53.70	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $104.71 / $158.49	Professional		$61.66	$104.71	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $15.85 / $23.44	Professional	26	$9.12	$15.85	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $91.20 / $134.90	Professional	TC	$51.29	$91.20	$134.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $134.90 / $162.18	Professional		$109.65	$134.90	$162.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.50 / $23.44	Professional	26	$15.14	$19.50	$23.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $114.82 / $138.04	Professional	TC	$89.13	$114.82	$138.04
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $16.22 / $194.98	Facility	26	$11.22	$16.22	$194.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $107.15 / $154.88	Professional		$69.18	$107.15	$154.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $17.38 / $24.55	Professional	26	$9.33	$17.38	$24.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $100.00 / $134.90	Professional	TC	$60.26	$100.00	$134.90
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $16.98 / $17.38	Facility	26	$14.45	$16.98	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.79 / $19.05	Professional	26	$11.48	$14.79	$19.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $77.62 / $97.72	Professional	TC	$58.88	$77.62	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $154.88	Professional		$79.43	$120.23	$154.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $16.98 / $23.44	Professional	26	$10.47	$16.98	$23.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $93.33 / $134.90	Professional	TC	$54.95	$93.33	$134.90
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $151.36	Professional		$87.10	$117.49	$151.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $17.78 / $23.44	Professional	26	$13.49	$17.78	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $100.00 / $128.82	Professional	TC	$74.13	$100.00	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $107.15 / $154.88	Professional		$67.61	$107.15	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $25.12	Professional	26	$10.96	$17.38	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $89.13 / $131.83	Professional	TC	$56.23	$89.13	$131.83