Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $234.42 / $478.63	Facility		$40.74	$234.42	$478.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $19.05 / $67.61	Facility	26	$12.02	$19.05	$67.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $151.36 / $316.23	Facility	TC	$23.99	$151.36	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $30.20 / $87.10	Professional		$18.62	$30.20	$87.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $37.15	Professional	26	$7.94	$12.02	$37.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $19.05 / $40.74	Professional	TC	$10.00	$19.05	$40.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $239.88 / $302.00	Facility		$19.05	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $45.71 / $74.13	Professional		$21.88	$45.71	$74.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.22 / $25.12	Professional	26	$10.00	$16.22	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $30.20 / $50.12	Professional	TC	$11.75	$30.20	$50.12
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $21.38 / $22.91	Professional	26	$21.38	$21.38	$22.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $54.95 / $70.79	Professional		$48.98	$54.95	$70.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.20 / $22.39	Professional	26	$15.85	$18.20	$22.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $37.15 / $47.86	Professional	TC	$33.11	$37.15	$47.86
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $70.79 / $426.58	Facility		$23.44	$70.79	$426.58
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $17.38 / $33.88	Facility	26	$12.02	$17.38	$33.88
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $162.18 / $398.11	Facility	TC	$23.44	$162.18	$398.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $50.12 / $77.62	Professional		$25.12	$50.12	$77.62
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $16.22 / $27.54	Professional	26	$8.32	$16.22	$27.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $33.88 / $51.29	Professional	TC	$14.45	$33.88	$51.29
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $51.29 / $51.29	Facility		$35.48	$51.29	$51.29
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $17.38	Facility	26	$13.80	$16.60	$17.38
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $33.88 / $34.67	Facility	TC	$28.84	$33.88	$34.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.13 / $17.38	Professional	26	$10.47	$14.13	$17.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $34.67	Professional	TC	$22.91	$30.90	$34.67
Providence Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $37.15 / $69.18	Facility		$21.38	$37.15	$69.18
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.14 / $10.00 / $14.13	Facility	26	$2.14	$10.00	$14.13
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $4.07 / $19.05 / $26.92	Facility	TC	$4.07	$19.05	$26.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $53.70 / $75.86	Professional		$37.15	$53.70	$75.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $18.20 / $25.70	Professional	26	$11.75	$18.20	$25.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $34.67 / $51.29	Professional	TC	$19.05	$34.67	$51.29
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $281.84 / $354.81	Facility		$204.17	$281.84	$354.81
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	TC	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $51.29 / $69.18	Professional		$35.48	$51.29	$69.18
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $18.20 / $23.44	Professional	26	$15.49	$18.20	$23.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $34.67 / $45.71	Professional	TC	$20.89	$34.67	$45.71
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $323.59 / $426.58	Facility		$263.03	$323.59	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $27.54 / $67.61	Professional		$19.95	$27.54	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $11.75 / $23.99	Professional	26	$9.12	$11.75	$23.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $17.78 / $45.71	Professional	TC	$10.72	$17.78	$45.71