Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.90 / $37.65 / $72.86	Facility	26	$32.90	$37.65	$72.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $70.84 / $73.58 / $170.18	Facility	TC	$70.84	$73.58	$170.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.58 / $45.38 / $182.40	Professional		$37.58	$45.38	$182.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.21 / $16.69 / $37.01	Professional	26	$12.21	$16.69	$37.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $29.72 / $71.66	Professional	TC	$23.51	$29.72	$71.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	26	$16.60	$16.60	$16.60
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 $45.89 / $84.04 / $126.05	Professional		$45.89	$84.04	$126.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $30.19 / $44.57	Professional	26	$17.80	$30.19	$44.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.34 / $56.22 / $87.31	Professional	TC	$28.34	$56.22	$87.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $90.33 / $107.17 / $123.87	Professional		$90.33	$107.17	$123.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.25 / $33.81 / $38.06	Professional	26	$28.25	$33.81	$38.06
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $61.21 / $73.08 / $85.81	Professional	TC	$61.21	$73.08	$85.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.63 / $77.54 / $141.30	Professional		$49.63	$77.54	$141.30
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.48 / $31.22 / $44.75	Professional	26	$23.48	$31.22	$44.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.63 / $65.56 / $96.57	Professional	TC	$49.63	$65.56	$96.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $18.92 / $28.81 / $30.82	Facility	26	$18.92	$28.81	$30.82
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $51.14 / $59.84 / $62.98	Facility	TC	$51.14	$59.84	$62.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $23.65 / $30.82	Professional	26	$15.92	$23.65	$30.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.11 / $61.21 / $62.98	Professional	TC	$45.11	$61.21	$62.98
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	26	$16.60	$16.60	$16.60
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 $69.62 / $99.39 / $131.10	Professional		$69.62	$99.39	$131.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.93 / $30.79 / $44.57	Professional	26	$19.93	$30.79	$44.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.72 / $60.07 / $88.22	Professional	TC	$37.72	$60.07	$88.22
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 $83.19 / $98.46 / $131.69	Professional		$83.19	$98.46	$131.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.33 / $33.39 / $42.06	Professional	26	$26.33	$33.39	$42.06
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $53.06 / $66.22 / $90.01	Professional	TC	$53.06	$66.22	$90.01
United Facility/Professional Professional Modifier Low / Median / High Price $42.40 / $66.20 / $129.02	Professional		$42.40	$66.20	$129.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $20.62 / $46.81	Professional	26	$16.48	$20.62	$46.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.87 / $33.88 / $82.55	Professional	TC	$25.87	$33.88	$82.55