Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.96 / $33.51 / $67.86	Facility	26	$22.96	$33.51	$67.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $54.09 / $73.58 / $171.08	Facility	TC	$54.09	$73.58	$171.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.39 / $50.79 / $140.27	Professional		$34.39	$50.79	$140.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.09 / $16.87 / $68.98	Professional	26	$11.09	$16.87	$68.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.47 / $34.53 / $78.39	Professional	TC	$23.47	$34.53	$78.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Facility	26	$15.41	$15.41	$15.41
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.04 / $35.04 / $35.04	Facility	TC	$35.04	$35.04	$35.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.20 / $88.17 / $131.77	Professional		$50.20	$88.17	$131.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $30.46 / $42.36	Professional	26	$17.89	$30.46	$42.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.19 / $57.56 / $88.25	Professional	TC	$33.19	$57.56	$88.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $88.32 / $104.89 / $121.32	Professional		$88.32	$104.89	$121.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.66 / $30.72 / $34.58	Professional	26	$25.66	$30.72	$34.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.87 / $73.88 / $86.72	Professional	TC	$61.87	$73.88	$86.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.44 / $83.21 / $136.22	Professional		$69.44	$83.21	$136.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.35 / $30.00 / $40.65	Professional	26	$21.35	$30.00	$40.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.14 / $58.74 / $95.55	Professional	TC	$40.14	$58.74	$95.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.99 / $26.80 / $33.32	Facility	26	$21.99	$26.80	$33.32
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.59 / $56.55 / $62.98	Facility	TC	$44.59	$56.55	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.70 / $26.80 / $34.29	Professional	26	$19.70	$26.80	$34.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.97 / $49.55 / $61.38	Professional	TC	$34.97	$49.55	$61.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.41 / $15.41 / $15.41	Facility	26	$15.41	$15.41	$15.41
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $35.04 / $35.04 / $35.04	Facility	TC	$35.04	$35.04	$35.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.25 / $97.15 / $129.97	Professional		$72.25	$97.15	$129.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.12 / $30.59 / $44.89	Professional	26	$18.12	$30.59	$44.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.55 / $62.13 / $88.25	Professional	TC	$42.55	$62.13	$88.25
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 $80.20 / $94.81 / $122.75	Professional		$80.20	$94.81	$122.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $31.06 / $39.11	Professional	26	$23.94	$31.06	$39.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $55.74 / $65.33 / $85.74	Professional	TC	$55.74	$65.33	$85.74
United Facility/Professional Professional Modifier Low / Median / High Price $44.75 / $63.18 / $128.16	Professional		$44.75	$63.18	$128.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $19.30 / $42.39	Professional	26	$14.80	$19.30	$42.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.67 / $34.28 / $85.64	Professional	TC	$27.67	$34.28	$85.64