Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.39 / $25.25 / $140.96	Facility		$19.39	$25.25	$140.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.12 / $16.60 / $39.06	Facility	26	$13.12	$16.60	$39.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.19 / $13.63 / $36.89	Professional		$11.19	$13.63	$36.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $8.83 / $20.98	Professional	26	$7.61	$8.83	$20.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $11.36 / $11.36 / $12.27	Professional	50	$11.36	$11.36	$12.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $3.54 / $4.45 / $9.63	Professional	TC	$3.54	$4.45	$9.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3.88 / $68.26 / $84.61	Facility		$3.88	$68.26	$84.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $14.30 / $26.65 / $35.00	Professional		$14.30	$26.65	$35.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $17.80 / $23.74	Professional	26	$10.54	$17.80	$23.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $4.80 / $9.00 / $12.77	Professional	TC	$4.80	$9.00	$12.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $21.48 / $25.03 / $29.73	Professional		$21.48	$25.03	$29.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.56 / $17.07 / $19.89	Professional	26	$14.56	$17.07	$19.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $6.83 / $7.97 / $9.84	Professional	TC	$6.83	$7.97	$9.84
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $11.45 / $20.48 / $36.52	Facility		$11.45	$20.48	$36.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $16.50 / $22.22 / $34.56	Professional		$16.50	$22.22	$34.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $16.50 / $24.40	Professional	26	$12.28	$16.50	$24.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.87 / $7.26 / $11.68	Professional	TC	$5.87	$7.26	$11.68
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $18.68 / $22.13 / $28.81	Facility		$18.68	$22.13	$28.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.64 / $15.10 / $18.76	Facility	26	$12.64	$15.10	$18.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.67 / $14.35 / $20.16	Professional	26	$10.67	$14.35	$20.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $5.13 / $7.37 / $10.71	Professional	TC	$5.13	$7.37	$10.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $13.47 / $27.74 / $37.40	Facility		$13.47	$27.74	$37.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $20.74 / $27.03 / $33.92	Professional		$20.74	$27.03	$33.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.68 / $17.93 / $24.37	Professional	26	$10.68	$17.93	$24.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $5.78 / $9.23 / $12.78	Professional	TC	$5.78	$9.23	$12.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $56.78 / $84.63 / $111.38	Facility		$56.78	$84.63	$111.38
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $58.88 / $58.88	Facility	26	$58.88	$58.88	$58.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $21.42 / $27.51 / $32.61	Professional		$21.42	$27.51	$32.61
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.20 / $18.46 / $22.06	Professional	26	$14.20	$18.46	$22.06
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $6.93 / $9.02 / $10.55	Professional	TC	$6.93	$9.02	$10.55
United Facility/Professional Facility Modifier Low / Median / High Price $74.45 / $74.45 / $92.00	Facility		$74.45	$74.45	$92.00
United Facility/Professional Professional Modifier Low / Median / High Price $12.27 / $15.45 / $37.72	Professional		$12.27	$15.45	$37.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.30 / $10.06 / $24.46	Professional	26	$8.30	$10.06	$24.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $3.97 / $5.39 / $11.71	Professional	TC	$3.97	$5.39	$11.71