Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $194.98 / $380.19	Facility		$43.65	$194.98	$380.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $18.20 / $33.88	Facility	26	$11.48	$18.20	$33.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $53.70 / $489.78	Facility	TC	$27.54	$53.70	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $36.31 / $97.72	Professional		$24.55	$36.31	$97.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $31.62	Professional	26	$7.94	$12.02	$31.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.44 / $45.71	Professional	TC	$15.85	$23.44	$45.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $302.00 / $371.54	Facility		$21.38	$302.00	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $53.70 / $87.10	Professional		$28.84	$53.70	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.22 / $25.12	Professional	26	$9.33	$16.22	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $37.15 / $63.10	Professional	TC	$19.95	$37.15	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $60.26 / $75.86	Professional		$53.70	$60.26	$75.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $17.78 / $21.38	Professional	26	$15.85	$17.78	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $42.66 / $53.70	Professional	TC	$38.02	$42.66	$53.70
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $48.98 / $288.40	Facility		$27.54	$48.98	$288.40
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $16.22 / $24.55	Facility	26	$11.48	$16.22	$24.55
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $45.71 / $489.78	Facility	TC	$26.92	$45.71	$489.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $48.98 / $75.86	Professional		$30.90	$48.98	$75.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.14 / $24.55	Professional	26	$8.71	$15.14	$24.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.02 / $54.95	Professional	TC	$20.89	$38.02	$54.95
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $54.95 / $60.26	Facility		$43.65	$54.95	$60.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.98	Facility	26	$13.80	$16.60	$16.98
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $37.15 / $39.81	Facility	TC	$30.90	$37.15	$39.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $18.62	Professional	26	$10.00	$15.14	$18.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $31.62 / $44.67	Professional	TC	$22.39	$31.62	$44.67
Providence Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $43.65 / $75.86	Facility		$27.54	$43.65	$75.86
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $4.57 / $21.38 / $30.20	Facility	TC	$4.57	$21.38	$30.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $60.26 / $83.18	Professional		$44.67	$60.26	$83.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $24.55	Professional	26	$11.75	$17.78	$24.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $58.88	Professional	TC	$28.18	$40.74	$58.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $371.54 / $467.74	Facility		$295.12	$371.54	$467.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	TC	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $58.88 / $75.86	Professional		$50.12	$58.88	$75.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $17.78 / $22.91	Professional	26	$15.14	$17.78	$22.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $41.69 / $54.95	Professional	TC	$34.67	$41.69	$54.95
United Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $389.05 / $512.86	Facility		$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $33.88 / $79.43	Professional		$27.54	$33.88	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.72 / $23.44	Professional	26	$8.32	$10.72	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $23.44 / $56.23	Professional	TC	$18.20	$23.44	$56.23