Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.80 / $13.70 / $30.40	Facility	26	$8.80	$13.70	$30.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.38 / $63.65 / $291.95	Facility	TC	$33.38	$63.65	$291.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.94 / $39.17 / $123.00	Professional		$18.94	$39.17	$123.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.53 / $8.75 / $26.31	Professional	26	$5.53	$8.75	$26.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.01 / $31.83 / $97.00	Professional	TC	$21.01	$31.83	$97.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.31 / $7.31 / $7.31	Facility	26	$7.31	$7.31	$7.31
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $25.73 / $25.73 / $25.73	Facility	TC	$25.73	$25.73	$25.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.13 / $56.32 / $81.20	Professional		$30.13	$56.32	$81.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.01 / $12.36 / $18.25	Professional	26	$7.01	$12.36	$18.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $44.24 / $64.66	Professional	TC	$23.82	$44.24	$64.66
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.13 / $68.11 / $78.90	Professional		$57.13	$68.11	$78.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $12.08 / $14.46 / $16.28	Professional	26	$12.08	$14.46	$16.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.70 / $53.37 / $62.65	Professional	TC	$44.70	$53.37	$62.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $38.50 / $49.25 / $87.32	Professional		$38.50	$49.25	$87.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $12.28 / $19.32	Professional	26	$10.15	$12.28	$19.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $46.65 / $70.14	Professional	TC	$36.29	$46.65	$70.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $9.31 / $12.35 / $12.73	Facility	26	$9.31	$12.35	$12.73
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $29.07 / $41.07 / $46.23	Facility	TC	$29.07	$41.07	$46.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.60 / $10.83 / $13.11	Professional	26	$7.60	$10.83	$13.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.02 / $34.72 / $46.62	Professional	TC	$25.02	$34.72	$46.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.31 / $7.31 / $7.31	Facility	26	$7.31	$7.31	$7.31
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $25.73 / $25.73 / $25.73	Facility	TC	$25.73	$25.73	$25.73
Providence Facility/Professional Professional Modifier Low / Median / High Price $46.27 / $62.64 / $83.60	Professional		$46.27	$62.64	$83.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $12.57 / $18.68	Professional	26	$8.61	$12.57	$18.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.80 / $45.73 / $64.66	Professional	TC	$30.80	$45.73	$64.66
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 $52.67 / $61.16 / $80.06	Professional		$52.67	$61.16	$80.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $11.37 / $13.44 / $18.00	Professional	26	$11.37	$13.44	$18.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.30 / $47.96 / $62.78	Professional	TC	$41.30	$47.96	$62.78
United Facility/Professional Professional Modifier Low / Median / High Price $28.03 / $33.79 / $81.53	Professional		$28.03	$33.79	$81.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.81 / $7.49 / $19.62	Professional	26	$6.81	$7.49	$19.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.20 / $27.56 / $62.46	Professional	TC	$21.20	$27.56	$62.46