Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $194.98 / $436.52	Facility		$64.57	$194.98	$436.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $24.55 / $44.67	Facility	26	$14.79	$24.55	$44.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.66 / $154.88 / $316.23	Facility	TC	$42.66	$154.88	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $53.70 / $169.82	Professional		$33.88	$53.70	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.85 / $45.71	Professional	26	$10.00	$15.85	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $43.65 / $77.62	Professional	TC	$23.44	$43.65	$77.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $239.88 / $302.00	Facility		$31.62	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $74.13 / $112.20	Professional		$36.31	$74.13	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $20.42 / $32.36	Professional	26	$11.75	$20.42	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $53.70 / $83.18	Professional	TC	$25.12	$53.70	$83.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $85.11 / $107.15	Professional		$75.86	$85.11	$107.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $27.54	Professional	26	$19.50	$22.91	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $63.10 / $79.43	Professional	TC	$56.23	$63.10	$79.43
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $69.18 / $354.81	Facility		$38.02	$69.18	$354.81
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.38 / $41.69	Facility	26	$14.79	$21.38	$41.69
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $40.74 / $194.98 / $363.08	Facility	TC	$40.74	$194.98	$363.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $69.18 / $117.49	Professional		$42.66	$69.18	$117.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.95 / $33.11	Professional	26	$10.96	$19.95	$33.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $54.95 / $81.28	Professional	TC	$29.51	$54.95	$81.28
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $70.79 / $79.43	Facility		$52.48	$70.79	$79.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.88	Facility	26	$17.78	$20.89	$21.88
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $50.12 / $58.88	Facility	TC	$34.67	$50.12	$58.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $23.99	Professional	26	$13.80	$19.50	$23.99
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $40.74 / $57.54	Professional	TC	$28.84	$40.74	$57.54
Providence Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $58.88 / $102.33	Facility		$38.02	$58.88	$102.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	TC	$6.76	$31.62	$44.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $79.43 / $114.82	Professional		$58.88	$79.43	$114.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $31.62	Professional	26	$15.14	$22.91	$31.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $53.70 / $83.18	Professional	TC	$35.48	$53.70	$83.18
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $281.84 / $363.08	Facility		$204.17	$281.84	$363.08
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 $64.57 / $81.28 / $104.71	Professional		$64.57	$81.28	$104.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $29.51	Professional	26	$19.50	$22.91	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $56.23 / $75.86	Professional	TC	$41.69	$56.23	$75.86
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 $33.11 / $44.67 / $104.71	Professional		$33.11	$44.67	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.18 / $29.51	Professional	26	$10.23	$13.18	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $75.86	Professional	TC	$21.88	$31.62	$75.86