Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.69 / $19.59 / $44.23	Facility	26	$12.69	$19.59	$44.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.85 / $53.53 / $130.19	Facility	TC	$34.85	$53.53	$130.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.80 / $38.59 / $117.46	Professional		$24.80	$38.59	$117.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $12.54 / $40.79	Professional	26	$8.46	$12.54	$40.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.47 / $22.55 / $54.79	Professional	TC	$17.47	$22.55	$54.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.15 / $27.15 / $27.15	Facility	TC	$27.15	$27.15	$27.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.96 / $59.19 / $92.17	Professional		$31.96	$59.19	$92.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.43 / $17.72 / $26.06	Professional	26	$10.43	$17.72	$26.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.83 / $42.55 / $68.45	Professional	TC	$21.83	$42.55	$68.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.76 / $78.23 / $90.58	Professional		$65.76	$78.23	$90.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $20.68 / $23.29	Professional	26	$17.23	$20.68	$23.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.99 / $57.30 / $67.27	Professional	TC	$47.99	$57.30	$67.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.84 / $62.11 / $100.65	Professional		$49.84	$62.11	$100.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $18.73 / $27.45	Professional	26	$14.40	$18.73	$27.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.96 / $55.48 / $76.02	Professional	TC	$38.96	$55.48	$76.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.08 / $17.78 / $18.09	Facility	26	$13.08	$17.78	$18.09
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.73 / $41.79 / $48.24	Facility	TC	$28.73	$41.79	$48.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.88 / $16.20 / $19.04	Professional	26	$11.88	$16.20	$19.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.79 / $39.60 / $48.05	Professional	TC	$26.79	$39.60	$48.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $27.15 / $27.15 / $27.15	Facility	TC	$27.15	$27.15	$27.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.97 / $70.33 / $94.05	Professional		$48.97	$70.33	$94.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.12 / $18.42 / $26.55	Professional	26	$12.12	$18.42	$26.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.37 / $45.65 / $68.45	Professional	TC	$30.37	$45.65	$68.45
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 $51.04 / $68.80 / $90.07	Professional		$51.04	$68.80	$90.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $19.19 / $25.58	Professional	26	$16.16	$19.19	$25.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.44 / $49.32 / $65.51	Professional	TC	$34.44	$49.32	$65.51
United Facility/Professional Professional Modifier Low / Median / High Price $29.82 / $39.54 / $92.00	Professional		$29.82	$39.54	$92.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.67 / $10.53 / $27.64	Professional	26	$9.67	$10.53	$27.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $25.09 / $64.00	Professional	TC	$20.12	$25.09	$64.00