Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.39 / $23.31 / $56.03	Facility	26	$15.39	$23.31	$56.03
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $49.32 / $90.93 / $465.60	Facility	TC	$49.32	$90.93	$465.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.76 / $58.31 / $189.13	Professional		$25.76	$58.31	$189.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.52 / $18.32 / $51.26	Professional	26	$10.52	$18.32	$51.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $84.50 / $128.44 / $253.14	Professional	50	$84.50	$128.44	$253.14
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.08 / $24.58 / $64.37	Professional	52	$15.08	$24.58	$64.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $49.32 / $120.10	Professional	TC	$27.87	$49.32	$120.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Facility	26	$12.66	$12.66	$12.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $40.63 / $40.63 / $40.63	Facility	TC	$40.63	$40.63	$40.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.26 / $81.93 / $131.44	Professional		$43.26	$81.93	$131.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $21.29 / $31.10	Professional	26	$12.42	$21.29	$31.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.50 / $63.36 / $102.39	Professional	TC	$31.50	$63.36	$102.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.56 / $111.35 / $129.16	Professional		$93.56	$111.35	$129.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $25.36 / $28.56	Professional	26	$21.12	$25.36	$28.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $71.77 / $85.70 / $100.61	Professional	TC	$71.77	$85.70	$100.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $65.52 / $80.38 / $139.50	Professional		$65.52	$80.38	$139.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.61 / $21.35 / $33.54	Professional	26	$17.61	$21.35	$33.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.95 / $63.82 / $108.78	Professional	TC	$40.95	$63.82	$108.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $21.44 / $22.11	Facility	26	$15.68	$21.44	$22.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $39.77 / $60.97 / $73.03	Facility	TC	$39.77	$60.97	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $20.37 / $23.38	Professional	26	$14.59	$20.37	$23.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.58 / $53.60 / $73.19	Professional	TC	$36.58	$53.60	$73.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.66 / $12.66 / $12.66	Facility	26	$12.66	$12.66	$12.66
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $40.63 / $40.63 / $40.63	Facility	TC	$40.63	$40.63	$40.63
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.36 / $99.01 / $131.44	Professional		$67.36	$99.01	$131.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.50 / $21.79 / $32.45	Professional	26	$14.50	$21.79	$32.45
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $50.45 / $53.44 / $53.44	Professional	52	$50.45	$53.44	$53.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.94 / $69.68 / $102.39	Professional	TC	$41.94	$69.68	$102.39
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.91 / $97.27 / $127.37	Professional		$79.91	$97.27	$127.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $22.94 / $30.69	Professional	26	$19.75	$22.94	$30.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $59.04 / $73.58 / $97.35	Professional	TC	$59.04	$73.58	$97.35
United Facility/Professional Professional Modifier Low / Median / High Price $40.25 / $48.48 / $126.94	Professional		$40.25	$48.48	$126.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $13.40 / $34.51	Professional	26	$11.18	$13.40	$34.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.03 / $35.49 / $95.04	Professional	TC	$28.03	$35.49	$95.04