Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.12 / $265.36 / $435.01	Facility		$62.12	$265.36	$435.01
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.90 / $23.31 / $54.20	Facility	26	$14.90	$23.31	$54.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.96 / $327.60 / $502.55	Facility	TC	$48.96	$327.60	$502.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $55.00 / $163.58	Professional		$36.65	$55.00	$163.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.36 / $15.37 / $48.40	Professional	26	$10.36	$15.37	$48.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $40.57 / $116.00	Professional	TC	$26.62	$40.57	$116.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $32.14 / $301.52 / $367.38	Facility		$32.14	$301.52	$367.38
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 $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.96 / $74.36 / $110.51	Professional		$38.96	$74.36	$110.51
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 $28.14 / $52.12 / $81.65	Professional	TC	$28.14	$52.12	$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 $35.54 / $72.40 / $119.26	Facility		$35.54	$72.40	$119.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.68 / $67.36 / $119.45	Professional		$57.68	$67.36	$119.45
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 / $56.90 / $89.46	Professional	TC	$46.43	$56.90	$89.46
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $48.02 / $69.43 / $80.40	Facility		$48.02	$69.43	$80.40
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 $38.19 / $50.25 / $58.96	Facility	TC	$38.19	$50.25	$58.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.67 / $20.00 / $23.36	Professional	26	$13.67	$20.00	$23.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.55 / $44.89 / $58.80	Professional	TC	$30.55	$44.89	$58.80
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.51 / $86.40 / $119.64	Facility		$41.51	$86.40	$119.64
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 $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.22 / $83.93 / $113.05	Professional		$59.22	$83.93	$113.05
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 $36.79 / $57.32 / $82.57	Professional	TC	$36.79	$57.32	$82.57
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.48 / $82.20 / $109.18	Professional		$66.48	$82.20	$109.18
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 $46.13 / $60.28 / $80.06	Professional	TC	$46.13	$60.28	$80.06
United Facility/Professional Professional Modifier Low / Median / High Price $35.21 / $57.77 / $124.31	Professional		$35.21	$57.77	$124.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.02 / $33.03	Professional	26	$11.48	$15.02	$33.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.35 / $29.30 / $77.41	Professional	TC	$23.35	$29.30	$77.41