Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.17 / $25.03 / $105.78	Facility	26	$21.17	$25.03	$105.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.85 / $73.36 / $371.00	Professional		$22.85	$73.36	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $12.40 / $55.79	Professional	26	$8.83	$12.40	$55.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.19 / $63.97 / $285.00	Professional	TC	$14.19	$63.97	$285.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $5.59 / $5.59 / $5.59	Facility	53	$5.59	$5.59	$5.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.10 / $52.82 / $99.71	Professional		$31.10	$52.82	$99.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.35 / $27.09	Professional	26	$11.22	$18.35	$27.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.44 / $32.75 / $78.75	Professional	TC	$18.44	$32.75	$78.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $50.60 / $56.51 / $69.11	Professional		$50.60	$56.51	$69.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $20.64 / $24.07	Professional	26	$17.89	$20.64	$24.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.15 / $36.47 / $45.05	Professional	TC	$32.15	$36.47	$45.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $39.60 / $58.54 / $110.25	Professional		$39.60	$58.54	$110.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $19.44 / $28.47	Professional	26	$14.95	$19.44	$28.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.15 / $33.22 / $51.99	Professional	TC	$26.15	$33.22	$51.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.72 / $18.46 / $19.04	Facility	26	$13.72	$18.46	$19.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $16.23 / $20.72	Professional	26	$11.26	$16.23	$20.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $17.86 / $27.74 / $98.34	Professional	TC	$17.86	$27.74	$98.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.80 / $10.80 / $10.80	Facility	26	$10.80	$10.80	$10.80
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $5.59 / $5.59 / $5.59	Facility	53	$5.59	$5.59	$5.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $54.26 / $75.23	Professional		$38.65	$54.26	$75.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.68 / $19.02 / $27.53	Professional	26	$12.68	$19.02	$27.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $32.75 / $64.54	Professional	TC	$19.48	$32.75	$64.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $43.09 / $52.89 / $81.23	Professional		$43.09	$52.89	$81.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.76 / $19.80 / $26.53	Professional	26	$16.76	$19.80	$26.53
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $24.97 / $32.58 / $49.65	Professional	TC	$24.97	$32.58	$49.65
United Facility/Professional Professional Modifier Low / Median / High Price $19.94 / $43.58 / $79.92	Professional		$19.94	$43.58	$79.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $12.58 / $28.95	Professional	26	$8.55	$12.58	$28.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.35 / $22.19 / $48.46	Professional	TC	$11.35	$22.19	$48.46