Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.86 / $142.61 / $401.78	Facility		$66.86	$142.61	$401.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.41 / $23.45 / $49.40	Facility	26	$14.41	$23.45	$49.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.74 / $233.65 / $624.00	Facility	TC	$39.74	$233.65	$624.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.66 / $46.43 / $137.00	Professional		$27.66	$46.43	$137.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.71 / $16.09 / $53.03	Professional	26	$9.71	$16.09	$53.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $32.31 / $69.34	Professional	TC	$17.92	$32.31	$69.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $25.53 / $223.86 / $304.19	Facility		$25.53	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.40 / $61.05 / $92.80	Professional		$33.40	$61.05	$92.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $20.36 / $30.02	Professional	26	$12.01	$20.36	$30.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.62 / $41.36 / $65.63	Professional	TC	$21.62	$41.36	$65.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.47 / $78.94 / $91.21	Professional		$66.47	$78.94	$91.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.85 / $23.73 / $26.72	Professional	26	$19.85	$23.73	$26.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $54.93 / $64.48	Professional	TC	$46.00	$54.93	$64.48
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $27.50 / $61.38 / $247.00	Facility		$27.50	$61.38	$247.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.84 / $57.85 / $102.69	Professional		$49.84	$57.85	$102.69
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $22.00 / $32.90	Professional	26	$16.55	$22.00	$32.90
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $48.95 / $71.16	Professional	TC	$37.36	$48.95	$71.16
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.60 / $62.20 / $67.67	Facility		$40.60	$62.20	$67.67
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.63 / $20.46 / $20.77	Facility	26	$13.63	$20.46	$20.77
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $38.49 / $45.56 / $46.90	Facility	TC	$38.49	$45.56	$46.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $27.73 / $30.81	Professional		$27.73	$27.73	$30.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.46 / $17.05 / $20.77	Professional	26	$12.46	$17.05	$20.77
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $31.21 / $46.01 / $46.90	Professional	TC	$31.21	$46.01	$46.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.81 / $80.30 / $106.05	Facility		$32.81	$80.30	$106.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.74 / $72.22 / $96.29	Professional		$50.74	$72.22	$96.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.89 / $21.15 / $30.48	Professional	26	$13.89	$21.15	$30.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.79 / $45.65 / $65.63	Professional	TC	$28.79	$45.65	$65.63
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $201.89 / $281.32 / $339.89	Facility		$201.89	$281.32	$339.89
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 $60.45 / $72.42 / $95.70	Professional		$60.45	$72.42	$95.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.55 / $22.95 / $29.37	Professional	26	$18.55	$22.95	$29.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.04 / $49.16 / $66.33	Professional	TC	$41.04	$49.16	$66.33
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $41.27 / $95.09	Professional		$30.90	$41.27	$95.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.13 / $12.38 / $32.04	Professional	26	$11.13	$12.38	$32.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.73 / $27.09 / $67.59	Professional	TC	$19.73	$27.09	$67.59