Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $138.04 / $407.38	Facility		$66.07	$138.04	$407.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $26.30 / $53.70	Facility	26	$14.45	$26.30	$53.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.74 / $234.42 / $630.96	Facility	TC	$40.74	$234.42	$630.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $50.12 / $165.96	Professional		$28.18	$50.12	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $16.22 / $46.77	Professional	26	$9.77	$16.22	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $34.67 / $67.61	Professional	TC	$18.20	$34.67	$67.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $239.88 / $302.00	Facility		$25.70	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $63.10 / $95.50	Professional		$32.36	$63.10	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.50 / $30.20	Professional	26	$11.75	$19.50	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $43.65 / $67.61	Professional	TC	$21.38	$43.65	$67.61
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $30.20	Professional	26	$26.30	$26.30	$30.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $72.44 / $91.20	Professional		$63.10	$72.44	$91.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $21.88 / $26.92	Professional	26	$19.05	$21.88	$26.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $50.12 / $64.57	Professional	TC	$44.67	$50.12	$64.57
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $97.72 / $363.08	Facility		$35.48	$97.72	$363.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $20.89 / $53.70	Facility	26	$14.45	$20.89	$53.70
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $37.15 / $245.47 / $870.96	Facility	TC	$37.15	$245.47	$870.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $63.10 / $104.71	Professional		$33.11	$63.10	$104.71
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $20.42 / $33.88	Professional	26	$10.00	$20.42	$33.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $44.67 / $69.18	Professional	TC	$21.88	$44.67	$69.18
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $66.07 / $67.61	Facility		$44.67	$66.07	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $20.42 / $20.89	Facility	26	$16.98	$20.42	$20.89
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $45.71 / $46.77	Facility	TC	$38.90	$45.71	$46.77
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $16.98 / $20.89	Professional	26	$12.30	$16.98	$20.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $46.77	Professional	TC	$34.67	$45.71	$46.77
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $47.86 / $89.13	Facility		$29.51	$47.86	$89.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.51 / $11.75 / $16.98	Facility	26	$2.51	$11.75	$16.98
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $5.37 / $25.12 / $36.31	Facility	TC	$5.37	$25.12	$36.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $70.79 / $97.72	Professional		$52.48	$70.79	$97.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $21.88 / $30.90	Professional	26	$13.80	$21.88	$30.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $47.86 / $69.18	Professional	TC	$30.20	$47.86	$69.18
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 $52.48 / $69.18 / $89.13	Professional		$52.48	$69.18	$89.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $21.88 / $28.18	Professional	26	$18.62	$21.88	$28.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $46.77 / $61.66	Professional	TC	$33.88	$46.77	$61.66
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 $30.90 / $38.90 / $87.10	Professional		$30.90	$38.90	$87.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $28.84	Professional	26	$10.96	$13.80	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $25.70 / $61.66	Professional	TC	$19.95	$25.70	$61.66