Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $16.16 / $40.13	Facility	26	$11.16	$16.16	$40.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.87 / $38.04 / $108.91	Professional		$17.87	$38.04	$108.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.42 / $39.60	Professional	26	$7.03	$11.42	$39.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $86.52 / $86.52 / $86.52	Professional	50	$86.52	$86.52	$86.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $26.39 / $61.86	Professional	TC	$18.82	$26.39	$61.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.13 / $56.58 / $90.44	Professional		$30.13	$56.58	$90.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.32 / $15.71 / $23.14	Professional	26	$9.32	$15.71	$23.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.62 / $43.05 / $69.40	Professional	TC	$21.62	$43.05	$69.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.44 / $76.70 / $88.87	Professional		$64.44	$76.70	$88.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $18.36 / $20.67	Professional	26	$15.31	$18.36	$20.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.66 / $58.10 / $68.20	Professional	TC	$48.66	$58.10	$68.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $42.00 / $53.68 / $96.37	Professional		$42.00	$53.68	$96.37
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $15.52 / $24.39	Professional	26	$12.80	$15.52	$24.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.97 / $47.40 / $74.22	Professional	TC	$34.97	$47.40	$74.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.60 / $16.07	Facility	26	$11.76	$15.60	$16.07
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.25 / $13.68 / $17.52	Professional	26	$9.25	$13.68	$17.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $34.36 / $49.58	Professional	TC	$22.11	$34.36	$49.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.24 / $67.31 / $91.20	Professional		$47.24	$67.31	$91.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.81 / $16.30 / $23.60	Professional	26	$10.81	$16.30	$23.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.15 / $47.71 / $69.40	Professional	TC	$29.15	$47.71	$69.40
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.68 / $67.13 / $88.25	Professional		$53.68	$67.13	$88.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $17.05 / $22.74	Professional	26	$14.36	$17.05	$22.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.74 / $50.58 / $66.42	Professional	TC	$38.74	$50.58	$66.42
United Facility/Professional Professional Modifier Low / Median / High Price $28.03 / $35.04 / $90.82	Professional		$28.03	$35.04	$90.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $9.46 / $24.76	Professional	26	$8.23	$9.46	$24.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $27.05 / $66.16	Professional	TC	$19.05	$27.05	$66.16