Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.32 / $46.18 / $64.70	Facility	26	$26.32	$46.18	$64.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.60 / $60.37 / $255.00	Professional		$45.60	$60.37	$255.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.85 / $32.10 / $75.25	Professional	26	$23.85	$32.10	$75.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.11 / $54.11 / $54.11	Professional	52	$54.11	$54.11	$54.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.88 / $27.22 / $132.00	Professional	TC	$19.88	$27.22	$132.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.28 / $39.28 / $39.28	Professional		$39.28	$39.28	$39.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.29 / $25.29 / $25.29	Professional	26	$25.29	$25.29	$25.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.99 / $13.99 / $13.99	Professional	TC	$13.99	$13.99	$13.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $86.16 / $102.30 / $116.70	Professional		$86.16	$102.30	$116.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.36 / $64.98 / $73.16	Professional	26	$54.36	$64.98	$73.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $31.05 / $37.07 / $43.54	Professional	TC	$31.05	$37.07	$43.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.45 / $93.09 / $140.06	Professional		$70.45	$93.09	$140.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $61.01 / $87.42	Professional	26	$45.36	$61.01	$87.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.08 / $35.72 / $70.27	Professional	TC	$25.08	$35.72	$70.27
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $41.67 / $56.03 / $57.62	Facility	26	$41.67	$56.03	$57.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.57 / $47.84 / $59.34	Professional	26	$34.57	$47.84	$59.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.85 / $32.38 / $49.70	Professional	TC	$25.85	$32.38	$49.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.40 / $32.40 / $32.40	Facility	26	$32.40	$32.40	$32.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.28 / $108.63 / $148.19	Professional		$39.28	$108.63	$148.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.29 / $25.29 / $25.29	Professional	26	$25.29	$25.29	$25.29
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $59.87 / $60.41 / $60.41	Professional	52	$59.87	$60.41	$60.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $13.99 / $13.99 / $13.99	Professional	TC	$13.99	$13.99	$13.99
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $64.77 / $64.77 / $64.77	Facility	26	$64.77	$64.77	$64.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.56 / $110.26 / $148.97	Professional		$85.56	$110.26	$148.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.57 / $60.70 / $81.48	Professional	26	$46.57	$60.70	$81.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.99 / $47.59 / $67.13	Professional	TC	$38.99	$47.59	$67.13
United Facility/Professional Professional Modifier Low / Median / High Price $56.72 / $69.37 / $159.96	Professional		$56.72	$69.37	$159.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.19 / $38.20 / $87.73	Professional	26	$32.19	$38.20	$87.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.26 / $30.06 / $72.34	Professional	TC	$25.26	$30.06	$72.34