Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.65 / $139.34 / $328.24	Facility		$58.65	$139.34	$328.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.82 / $19.64 / $43.91	Facility	26	$14.82	$19.64	$43.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $46.32 / $63.35 / $148.35	Facility	TC	$46.32	$63.35	$148.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.02 / $40.71 / $176.47	Professional		$29.02	$40.71	$176.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.79 / $12.05 / $56.54	Professional	26	$7.79	$12.05	$56.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.22 / $28.52 / $68.64	Professional	TC	$20.22	$28.52	$68.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.93 / $301.52 / $367.38	Facility		$29.93	$301.52	$367.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $30.58 / $30.58 / $30.58	Facility	TC	$30.58	$30.58	$30.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.42 / $70.08 / $105.78	Professional		$39.42	$70.08	$105.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $20.99 / $27.82	Professional	26	$12.81	$20.99	$27.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.36 / $48.49 / $76.94	Professional	TC	$26.36	$48.49	$76.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $71.05 / $84.58 / $97.98	Professional		$71.05	$84.58	$97.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $19.88 / $22.38	Professional	26	$16.60	$19.88	$22.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.94 / $64.40 / $75.59	Professional	TC	$53.94	$64.40	$75.59
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $31.49 / $64.89 / $92.61	Facility		$31.49	$64.89	$92.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $67.06 / $109.80	Professional		$56.00	$67.06	$109.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $19.76 / $26.43	Professional	26	$13.88	$19.76	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.56 / $52.52 / $83.37	Professional	TC	$43.56	$52.52	$83.37
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $49.42 / $67.00 / $72.36	Facility		$49.42	$67.00	$72.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.29 / $17.42 / $24.12	Facility	26	$14.29	$17.42	$24.12
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $36.26 / $47.57 / $54.94	Facility	TC	$36.26	$47.57	$54.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $18.89 / $24.75	Professional	26	$14.40	$18.89	$24.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.10 / $42.92 / $53.94	Professional	TC	$30.10	$42.92	$53.94
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.74 / $82.86 / $108.67	Facility		$37.74	$82.86	$108.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $30.58 / $30.58 / $30.58	Facility	TC	$30.58	$30.58	$30.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.78 / $77.58 / $103.79	Professional		$57.78	$77.58	$103.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $20.99 / $29.04	Professional	26	$12.81	$20.99	$29.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.43 / $53.20 / $76.94	Professional	TC	$35.43	$53.20	$76.94
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
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 $64.64 / $75.70 / $98.26	Professional		$64.64	$75.70	$98.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.56 / $21.33 / $25.58	Professional	26	$15.56	$21.33	$25.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.36 / $56.17 / $74.59	Professional	TC	$46.36	$56.17	$74.59
United Facility/Professional Facility Modifier Low / Median / High Price $323.25 / $323.25 / $399.40	Facility		$323.25	$323.25	$399.40
United Facility/Professional Professional Modifier Low / Median / High Price $35.93 / $42.16 / $103.37	Professional		$35.93	$42.16	$103.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $12.94 / $28.86	Professional	26	$10.41	$12.94	$28.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.69 / $27.69 / $72.69	Professional	TC	$23.69	$27.69	$72.69