Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $25.70 / $95.50	Facility	26	$14.79	$25.70	$95.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.98 / $100.00 / $954.99	Facility	TC	$48.98	$100.00	$954.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $58.88 / $199.53	Professional		$25.12	$58.88	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $18.20 / $53.70	Professional	26	$10.47	$18.20	$53.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $45.71 / $114.82 / $302.00	Professional	50	$45.71	$114.82	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $56.23 / $104.71	Professional	TC	$28.18	$56.23	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $87.10 / $134.90	Professional		$39.81	$87.10	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $20.89 / $33.11	Professional	26	$11.75	$20.89	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $64.57 / $104.71	Professional	TC	$30.20	$64.57	$104.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $107.15 / $131.83	Professional		$95.50	$107.15	$131.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $23.44 / $28.84	Professional	26	$20.89	$23.44	$28.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $83.18 / $102.33	Professional	TC	$74.13	$83.18	$102.33
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.88 / $95.50	Facility	26	$14.79	$21.88	$95.50
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $48.98 / $93.33 / $954.99	Facility	TC	$48.98	$93.33	$954.99
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $81.28 / $141.25	Professional		$43.65	$81.28	$141.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $20.89 / $35.48	Professional	26	$11.75	$20.89	$35.48
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $53.70 / $123.03 / $380.19	Professional	50	$53.70	$123.03	$380.19
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $69.18 / $104.71	Professional	TC	$34.67	$69.18	$104.71
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $21.38 / $21.88	Facility	26	$18.20	$21.38	$21.88
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $43.65 / $61.66 / $72.44	Facility	TC	$43.65	$61.66	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $23.44	Professional	26	$13.80	$19.50	$23.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.29 / $67.61	Professional	TC	$36.31	$51.29	$67.61
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $134.90	Professional		$70.79	$93.33	$134.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $32.36	Professional	26	$15.14	$22.91	$32.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $67.61 / $104.71	Professional	TC	$40.74	$67.61	$104.71
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	TC	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $93.33 / $123.03	Professional		$77.62	$93.33	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $29.51	Professional	26	$19.50	$22.91	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $93.33	Professional	TC	$53.70	$69.18	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $48.98 / $123.03	Professional		$39.81	$48.98	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.18 / $29.51	Professional	26	$10.72	$13.18	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $93.33	Professional	TC	$28.18	$36.31	$93.33