Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.40 / $24.06 / $50.01	Facility	26	$15.40	$24.06	$50.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.42 / $65.00 / $359.49	Facility	TC	$42.42	$65.00	$359.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $43.78 / $180.00	Professional		$30.19	$43.78	$180.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.31 / $15.95 / $58.49	Professional	26	$10.31	$15.95	$58.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $29.96 / $95.39	Professional	TC	$19.89	$29.96	$95.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.72 / $66.81 / $102.15	Professional		$36.72	$66.81	$102.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.77 / $21.70 / $31.87	Professional	26	$12.77	$21.70	$31.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $46.12 / $73.17	Professional	TC	$23.99	$46.12	$73.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.08 / $86.82 / $100.37	Professional		$73.08	$86.82	$100.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.14 / $25.30 / $28.48	Professional	26	$21.14	$25.30	$28.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.31 / $61.26 / $71.89	Professional	TC	$51.31	$61.26	$71.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.40 / $64.62 / $112.83	Professional		$56.40	$64.62	$112.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.61 / $23.41 / $33.54	Professional	26	$17.61	$23.41	$33.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.63 / $55.00 / $79.29	Professional	TC	$41.63	$55.00	$79.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.08 / $21.44 / $22.11	Facility	26	$14.08	$21.44	$22.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $42.89 / $51.00 / $52.26	Facility	TC	$42.89	$51.00	$52.26
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.27 / $17.60 / $22.66	Professional	26	$13.27	$17.60	$22.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.95 / $45.22 / $52.26	Professional	TC	$30.95	$45.22	$52.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.36 / $12.36 / $12.36	Facility	26	$12.36	$12.36	$12.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $55.46 / $79.75 / $106.12	Professional		$55.46	$79.75	$106.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.81 / $22.55 / $31.87	Professional	26	$14.81	$22.55	$31.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.94 / $51.14 / $73.17	Professional	TC	$31.94	$51.14	$73.17
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 $66.43 / $79.73 / $105.17	Professional		$66.43	$79.73	$105.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $24.43 / $31.27	Professional	26	$19.75	$24.43	$31.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.99 / $54.90 / $73.91	Professional	TC	$45.99	$54.90	$73.91
United Facility/Professional Professional Modifier Low / Median / High Price $33.74 / $45.12 / $122.81	Professional		$33.74	$45.12	$122.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $14.78 / $34.06	Professional	26	$11.55	$14.78	$34.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.92 / $26.52 / $70.17	Professional	TC	$21.92	$26.52	$70.17