Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.71 / $28.87 / $64.40	Facility	26	$17.71	$28.87	$64.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $50.43 / $152.38 / $395.20	Facility	TC	$50.43	$152.38	$395.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $45.21 / $212.00	Professional		$33.11	$45.21	$212.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.38 / $14.48 / $31.82	Professional	26	$10.38	$14.48	$31.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.72 / $29.35 / $67.84	Professional	TC	$22.72	$29.35	$67.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Facility	TC	$33.92	$33.92	$33.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.70 / $77.92 / $118.77	Professional		$42.70	$77.92	$118.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.12 / $25.37 / $37.46	Professional	26	$15.12	$25.37	$37.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.94 / $53.84 / $84.51	Professional	TC	$27.94	$53.84	$84.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $84.34 / $100.16 / $115.82	Professional		$84.34	$100.16	$115.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $29.15 / $32.82	Professional	26	$24.38	$29.15	$32.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.22 / $70.70 / $83.03	Professional	TC	$59.22	$70.70	$83.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.28 / $74.52 / $131.13	Professional		$63.28	$74.52	$131.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $26.96 / $38.64	Professional	26	$20.28	$26.96	$38.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.03 / $63.46 / $92.52	Professional	TC	$48.03	$63.46	$92.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.71 / $25.13 / $25.46	Facility	26	$16.71	$25.13	$25.46
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $49.49 / $59.16 / $60.97	Facility	TC	$49.49	$59.16	$60.97
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.28 / $20.89 / $25.46	Professional	26	$15.28	$20.89	$25.46
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.70 / $53.25 / $60.97	Professional	TC	$39.70	$53.25	$60.97
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.65 / $14.65 / $14.65	Facility	26	$14.65	$14.65	$14.65
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Facility	TC	$33.92	$33.92	$33.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.90 / $92.88 / $122.83	Professional		$64.90	$92.88	$122.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.21 / $26.42 / $37.46	Professional	26	$17.21	$26.42	$37.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.20 / $59.38 / $85.39	Professional	TC	$37.20	$59.38	$85.39
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 $77.20 / $91.95 / $122.23	Professional		$77.20	$91.95	$122.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $28.51 / $36.01	Professional	26	$22.74	$28.51	$36.01
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $52.36 / $64.84 / $86.22	Professional	TC	$52.36	$64.84	$86.22
United Facility/Professional Professional Modifier Low / Median / High Price $39.53 / $50.60 / $120.92	Professional		$39.53	$50.60	$120.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.70 / $15.37 / $38.90	Professional	26	$13.70	$15.37	$38.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.48 / $30.29 / $81.53	Professional	TC	$25.48	$30.29	$81.53