Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $57.54 / $363.08	Facility	26	$31.62	$57.54	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $83.18 / $223.87	Professional		$29.51	$83.18	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $48.98 / $134.90	Professional	26	$18.20	$48.98	$134.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $70.79 / $263.03	Professional	50	$36.31	$70.79	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $28.84 / $87.10	Professional	TC	$8.91	$28.84	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $97.72 / $173.78	Professional		$36.31	$97.72	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $52.48 / $89.13	Professional	26	$25.70	$52.48	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $48.98 / $91.20	Professional	TC	$12.59	$48.98	$91.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $165.96	Professional		$107.15	$138.04	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $79.43	Professional	26	$52.48	$67.61	$79.43
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $69.18 / $85.11	Professional	TC	$56.23	$69.18	$85.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $45.71 / $363.08	Facility	26	$31.62	$45.71	$363.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $112.20 / $177.83	Professional		$48.98	$112.20	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $63.10 / $97.72	Professional	26	$28.18	$63.10	$97.72
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $69.18 / $70.79 / $263.03	Professional	50	$69.18	$70.79	$263.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $60.26 / $85.11	Professional	TC	$19.95	$60.26	$85.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $53.70 / $64.57	Facility	26	$39.81	$53.70	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $57.54	Professional	26	$28.18	$41.69	$57.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $21.38 / $61.66	Professional	TC	$13.49	$21.38	$61.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $107.15 / $165.96	Professional		$67.61	$107.15	$165.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $53.70 / $85.11	Professional	26	$34.67	$53.70	$85.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $53.70 / $91.20	Professional	TC	$19.95	$53.70	$91.20
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 Professional Modifier Low / Median / High Price $77.62 / $120.23 / $158.49	Professional		$77.62	$120.23	$158.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $61.66 / $87.10	Professional	26	$42.66	$61.66	$87.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $64.57 / $85.11	Professional	TC	$19.50	$64.57	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $58.88 / $141.25	Professional		$36.31	$58.88	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.20 / $74.13	Professional	26	$23.99	$30.20	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $33.11 / $75.86	Professional	TC	$11.22	$33.11	$75.86