Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.50 / $15.91 / $37.08	Facility	26	$12.50	$15.91	$37.08
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.20 / $31.91 / $275.50	Facility	TC	$24.20	$31.91	$275.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.32 / $25.52 / $58.19	Professional		$17.32	$25.52	$58.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $8.69 / $34.11	Professional	26	$6.42	$8.69	$34.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.28 / $17.27 / $35.70	Professional	TC	$11.28	$17.27	$35.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.46 / $8.46 / $8.46	Facility	26	$8.46	$8.46	$8.46
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.03 / $16.03 / $16.03	Facility	TC	$16.03	$16.03	$16.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.22 / $43.09 / $63.92	Professional		$25.22	$43.09	$63.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $14.90 / $21.63	Professional	26	$8.16	$14.90	$21.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.39 / $28.43 / $42.29	Professional	TC	$17.39	$28.43	$42.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $42.63 / $50.65 / $58.39	Professional		$42.63	$50.65	$58.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.01 / $16.79 / $18.89	Professional	26	$14.01	$16.79	$18.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.17 / $33.64 / $39.49	Professional	TC	$28.17	$33.64	$39.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $34.50 / $40.38 / $66.09	Professional		$34.50	$40.38	$66.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.22 / $22.38	Professional	26	$11.75	$14.22	$22.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.95 / $29.85 / $43.71	Professional	TC	$22.95	$29.85	$43.71
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.78 / $14.44 / $15.41	Facility	26	$10.78	$14.44	$15.41
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $22.26 / $28.14 / $29.67	Facility	TC	$22.26	$28.14	$29.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $12.90 / $16.82	Professional	26	$8.84	$12.90	$16.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $17.64 / $25.20 / $31.75	Professional	TC	$17.64	$25.20	$31.75
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.46 / $8.46 / $8.46	Facility	26	$8.46	$8.46	$8.46
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $16.03 / $16.03 / $16.03	Facility	TC	$16.03	$16.03	$16.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.02 / $47.22 / $63.05	Professional		$36.02	$47.22	$63.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $15.27 / $22.18	Professional	26	$9.93	$15.27	$22.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.03 / $29.90 / $43.21	Professional	TC	$19.03	$29.90	$43.21
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 $38.90 / $46.19 / $59.78	Professional		$38.90	$46.19	$59.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.17 / $16.27 / $20.85	Professional	26	$13.17	$16.27	$20.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.74 / $30.75 / $39.11	Professional	TC	$25.74	$30.75	$39.11
United Facility/Professional Professional Modifier Low / Median / High Price $21.65 / $26.80 / $62.01	Professional		$21.65	$26.80	$62.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $8.78 / $22.71	Professional	26	$7.88	$8.78	$22.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.71 / $18.13 / $39.27	Professional	TC	$13.71	$18.13	$39.27