Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $41.69 / $45.71	Facility	26	$22.91	$41.69	$45.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $275.42	Professional		$54.95	$74.13	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $24.55 / $95.50	Professional	26	$16.22	$24.55	$95.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $48.98 / $199.53	Professional	50	$28.84	$48.98	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $81.28	Professional	TC	$38.02	$45.71	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $117.49 / $181.97	Professional		$67.61	$117.49	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $34.67 / $52.48	Professional	26	$19.95	$34.67	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $83.18 / $128.82	Professional	TC	$46.77	$83.18	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $144.54 / $165.96	Professional		$114.82	$144.54	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $39.81 / $46.77	Professional	26	$33.11	$39.81	$46.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $104.71 / $117.49	Professional	TC	$83.18	$104.71	$117.49
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $120.23 / $177.83	Professional		$70.79	$120.23	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $37.15 / $57.54	Professional	26	$19.05	$37.15	$57.54
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $48.98 / $199.53	Professional	50	$28.84	$48.98	$199.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $91.20 / $131.83	Professional	TC	$44.67	$91.20	$131.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $35.48 / $36.31	Facility	26	$29.51	$35.48	$36.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $38.02	Professional	26	$21.88	$29.51	$38.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $69.18 / $85.11	Professional	TC	$50.12	$69.18	$85.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $173.78	Professional		$91.20	$125.89	$173.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $35.48 / $52.48	Professional	26	$23.44	$35.48	$52.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $83.18 / $123.03	Professional	TC	$52.48	$83.18	$123.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $165.96	Professional		$100.00	$125.89	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $36.31 / $48.98	Professional	26	$28.84	$36.31	$48.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $117.49	Professional	TC	$67.61	$89.13	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $120.23 / $181.97	Professional		$69.18	$120.23	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $36.31 / $53.70	Professional	26	$22.39	$36.31	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $83.18 / $125.89	Professional	TC	$46.77	$83.18	$125.89