Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.16 / $167.58 / $385.48	Facility		$62.16	$167.58	$385.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.90 / $23.31 / $50.35	Facility	26	$14.90	$23.31	$50.35
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.89 / $155.94 / $314.64	Facility	TC	$42.89	$155.94	$314.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.10 / $53.92 / $161.13	Professional		$35.10	$53.92	$161.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $15.37 / $45.19	Professional	26	$10.02	$15.37	$45.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $39.61 / $88.61	Professional	TC	$25.05	$39.61	$88.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.77 / $223.86 / $304.19	Facility		$31.77	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.94 / $70.47 / $109.77	Professional		$36.94	$70.47	$109.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $21.04 / $31.10	Professional	26	$12.42	$21.04	$31.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.86 / $51.47 / $81.65	Professional	TC	$25.86	$51.47	$81.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.36 / $93.16 / $107.87	Professional		$78.36	$93.16	$107.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $24.54 / $27.62	Professional	26	$20.48	$24.54	$27.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.25 / $68.36 / $80.25	Professional	TC	$57.25	$68.36	$80.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.25 / $69.69 / $111.07	Facility		$35.25	$69.69	$111.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.50 / $67.36 / $120.99	Professional		$57.50	$67.36	$120.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $20.70 / $32.52	Professional	26	$17.07	$20.70	$32.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $56.27 / $88.44	Professional	TC	$46.43	$56.27	$88.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $45.06 / $69.01 / $79.73	Facility		$45.06	$69.01	$79.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $21.12 / $21.76	Facility	26	$15.68	$21.12	$21.76
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $34.77 / $50.05 / $58.29	Facility	TC	$34.77	$50.05	$58.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.67 / $19.30 / $23.68	Professional	26	$13.67	$19.30	$23.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.74 / $40.86 / $53.30	Professional	TC	$27.74	$40.86	$53.30
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.51 / $83.47 / $118.21	Facility		$41.51	$83.47	$118.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.08 / $83.28 / $112.10	Professional		$57.08	$83.28	$112.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.50 / $21.79 / $31.47	Professional	26	$14.50	$21.79	$31.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.04 / $56.63 / $81.65	Professional	TC	$34.04	$56.63	$81.65
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $201.89 / $281.32 / $339.90	Facility		$201.89	$281.32	$339.90
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 $65.92 / $81.52 / $108.27	Professional		$65.92	$81.52	$108.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $22.74 / $30.32	Professional	26	$19.14	$22.74	$30.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $45.51 / $58.55 / $79.15	Professional	TC	$45.51	$58.55	$79.15
United Facility/Professional Professional Modifier Low / Median / High Price $33.42 / $57.77 / $110.44	Professional		$33.42	$57.77	$110.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $13.30 / $33.03	Professional	26	$11.48	$13.30	$33.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.90 / $27.19 / $76.81	Professional	TC	$21.90	$27.19	$76.81