Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.94 / $29.62 / $66.18	Facility	26	$25.94	$29.62	$66.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $57.59 / $65.59 / $159.72	Facility	TC	$57.59	$65.59	$159.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $42.40 / $167.18	Professional		$32.36	$42.40	$167.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.38 / $14.49 / $32.67	Professional	26	$10.38	$14.49	$32.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.97 / $28.23 / $69.66	Professional	TC	$21.97	$28.23	$69.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.80 / $78.31 / $116.88	Professional		$42.80	$78.31	$116.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.46 / $26.23 / $38.72	Professional	26	$15.46	$26.23	$38.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $52.06 / $81.72	Professional	TC	$27.55	$52.06	$81.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.04 / $98.59 / $113.98	Professional		$83.04	$98.59	$113.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.02 / $29.95 / $33.72	Professional	26	$25.02	$29.95	$33.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.25 / $68.36 / $80.25	Professional	TC	$57.25	$68.36	$80.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.95 / $78.26 / $129.12	Professional		$64.95	$78.26	$129.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.82 / $27.51 / $39.65	Professional	26	$20.82	$27.51	$39.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $66.13 / $89.46	Professional	TC	$46.43	$66.13	$89.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.14 / $25.79 / $26.13	Facility	26	$17.14	$25.79	$26.13
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $47.84 / $57.24 / $58.96	Facility	TC	$47.84	$57.24	$58.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $21.44 / $26.13	Professional	26	$15.28	$21.44	$26.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.47 / $57.24 / $58.96	Professional	TC	$39.47	$57.24	$58.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.00 / $15.00 / $15.00	Facility	26	$15.00	$15.00	$15.00
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.90 / $90.81 / $121.84	Professional		$64.90	$90.81	$121.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.21 / $27.29 / $38.72	Professional	26	$17.21	$27.29	$38.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.68 / $57.45 / $82.57	Professional	TC	$36.68	$57.45	$82.57
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	TC	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $76.01 / $91.13 / $120.33	Professional		$76.01	$91.13	$120.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $29.24 / $36.95	Professional	26	$23.34	$29.24	$36.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.94 / $62.70 / $83.38	Professional	TC	$50.94	$62.70	$83.38
United Facility/Professional Professional Modifier Low / Median / High Price $39.53 / $45.24 / $119.70	Professional		$39.53	$45.24	$119.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.00 / $18.29 / $43.30	Professional	26	$14.00	$18.29	$43.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.13 / $79.59	Professional	TC	$25.12	$36.13	$79.59