Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $15.14 / $30.20	Facility	26	$9.33	$15.14	$30.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.66 / $125.89 / $309.03	Facility	TC	$42.66	$125.89	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $50.12 / $154.88	Professional		$19.95	$50.12	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.00 / $30.20	Professional	26	$6.03	$10.00	$30.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.20 / $128.82 / $181.97	Professional	50	$18.20	$128.82	$181.97
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.38 / $50.12 / $158.49	Professional	52	$17.38	$50.12	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $46.77 / $79.43	Professional	TC	$23.99	$46.77	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $67.61 / $109.65	Professional		$31.62	$67.61	$109.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $12.30 / $19.50	Professional	26	$7.08	$12.30	$19.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $56.23 / $91.20	Professional	TC	$23.99	$56.23	$91.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $85.11 / $104.71	Professional		$75.86	$85.11	$104.71
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.13 / $17.38	Professional	26	$12.59	$14.13	$17.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $70.79 / $87.10	Professional	TC	$63.10	$70.79	$87.10
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $13.49 / $30.20	Facility	26	$9.33	$13.49	$30.20
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $42.66 / $125.89 / $575.44	Facility	TC	$42.66	$125.89	$575.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $63.10 / $112.20	Professional		$31.62	$63.10	$112.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $12.02 / $21.38	Professional	26	$6.92	$12.02	$21.38
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $18.20 / $128.82 / $338.84	Professional	50	$18.20	$128.82	$338.84
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $10.47 / $17.38 / $158.49	Professional	52	$10.47	$17.38	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $58.88 / $89.13	Professional	TC	$27.54	$58.88	$89.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $13.18 / $13.49	Facility	26	$10.96	$13.18	$13.49
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $53.70 / $63.10	Facility	TC	$35.48	$53.70	$63.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.48 / $14.13	Professional	26	$7.94	$11.48	$14.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $42.66 / $56.23	Professional	TC	$30.20	$42.66	$56.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $1.62 / $7.59 / $10.96	Facility	26	$1.62	$7.59	$10.96
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $7.41 / $34.67 / $48.98	Facility	TC	$7.41	$34.67	$48.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $109.65	Professional		$54.95	$74.13	$109.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $13.80 / $19.50	Professional	26	$9.12	$13.80	$19.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $57.54 / $91.20	Professional	TC	$34.67	$57.54	$91.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	TC	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $75.86 / $100.00	Professional		$60.26	$75.86	$100.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $14.13 / $18.20	Professional	26	$12.02	$14.13	$18.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $83.18	Professional	TC	$46.77	$61.66	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $38.90 / $100.00	Professional		$28.84	$38.90	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.94 / $18.62	Professional	26	$6.46	$7.94	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $31.62 / $83.18	Professional	TC	$22.91	$31.62	$83.18