Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.13 / $30.68 / $66.00	Facility	26	$24.13	$30.68	$66.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $65.37 / $92.48 / $395.74	Facility	TC	$65.37	$92.48	$395.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $60.83 / $193.59	Professional		$44.27	$60.83	$193.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.41 / $17.00 / $37.70	Professional	26	$13.41	$17.00	$37.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $43.00 / $92.48	Professional	TC	$30.85	$43.00	$92.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.75 / $97.37 / $149.76	Professional		$52.75	$97.37	$149.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.64 / $27.80 / $41.38	Professional	26	$16.64	$27.80	$41.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.75 / $70.48 / $112.76	Professional	TC	$36.75	$70.48	$112.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.84 / $126.98 / $147.18	Professional		$106.84	$126.98	$147.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.97 / $32.29 / $36.36	Professional	26	$26.97	$32.29	$36.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.04 / $94.38 / $110.81	Professional	TC	$79.04	$94.38	$110.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $80.83 / $94.32 / $163.68	Professional		$80.83	$94.32	$163.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.42 / $29.81 / $42.69	Professional	26	$22.42	$29.81	$42.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.05 / $84.63 / $120.99	Professional	TC	$64.05	$84.63	$120.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.83 / $27.79 / $28.81	Facility	26	$20.83	$27.79	$28.81
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $48.43 / $70.09 / $80.40	Facility	TC	$48.43	$70.09	$80.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.26 / $23.09 / $31.39	Professional	26	$17.26	$23.09	$31.39
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.74 / $65.98 / $80.40	Professional	TC	$42.74	$65.98	$80.40
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.83 / $115.20 / $153.90	Professional		$80.83	$115.20	$153.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.03 / $29.21 / $41.39	Professional	26	$19.03	$29.21	$41.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $49.83 / $77.91 / $112.76	Professional	TC	$49.83	$77.91	$112.76
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 $84.26 / $112.59 / $146.47	Professional		$84.26	$112.59	$146.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $30.42 / $39.79	Professional	26	$25.14	$30.42	$39.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.81 / $82.20 / $108.27	Professional	TC	$57.81	$82.20	$108.27
United Facility/Professional Professional Modifier Low / Median / High Price $49.23 / $54.56 / $166.80	Professional		$49.23	$54.56	$166.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.16 / $19.27 / $43.01	Professional	26	$15.16	$19.27	$43.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $45.12 / $107.49	Professional	TC	$33.78	$45.12	$107.49