Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $33.88 / $54.95	Facility	26	$21.88	$33.88	$54.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $54.95 / $74.13 / $169.82	Facility	TC	$54.95	$74.13	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $51.29 / $134.90	Professional		$36.31	$51.29	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $67.61	Professional	26	$10.96	$17.38	$67.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $74.13	Professional	TC	$23.99	$33.88	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $89.13 / $134.90	Professional		$47.86	$89.13	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $27.54 / $44.67	Professional	26	$16.98	$27.54	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $60.26 / $93.33	Professional	TC	$33.11	$60.26	$93.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $97.72 / $120.23	Professional		$85.11	$97.72	$120.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $28.18 / $34.67	Professional	26	$25.12	$28.18	$34.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $67.61 / $87.10	Professional	TC	$58.88	$67.61	$87.10
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $33.88 / $54.95	Facility	26	$22.91	$33.88	$54.95
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $53.70 / $74.13 / $218.78	Facility	TC	$53.70	$74.13	$218.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $87.10 / $131.83	Professional		$51.29	$87.10	$131.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $27.54 / $39.81	Professional	26	$15.85	$27.54	$39.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $60.26 / $93.33	Professional	TC	$34.67	$60.26	$93.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $26.30 / $33.11	Facility	26	$21.88	$26.30	$33.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.67 / $56.23 / $63.10	Facility	TC	$44.67	$56.23	$63.10
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Professional		$45.71	$45.71	$45.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $26.30 / $33.11	Professional	26	$18.62	$26.30	$33.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $51.29 / $61.66	Professional	TC	$34.67	$51.29	$61.66
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	TC	$7.24	$33.88	$48.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $93.33 / $131.83	Professional		$72.44	$93.33	$131.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $32.36 / $42.66	Professional	26	$20.89	$32.36	$42.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $91.20	Professional	TC	$41.69	$61.66	$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 Facility Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	TC	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $95.50 / $120.23	Professional		$79.43	$95.50	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.90 / $38.90	Professional	26	$23.99	$30.90	$38.90
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $64.57 / $83.18	Professional	TC	$53.70	$64.57	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $53.70 / $120.23	Professional		$44.67	$53.70	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $18.62 / $41.69	Professional	26	$14.79	$18.62	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $35.48 / $81.28	Professional	TC	$28.18	$35.48	$81.28