Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $141.25 / $338.84	Facility		$51.29	$141.25	$338.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $18.20 / $22.91	Facility	26	$11.48	$18.20	$22.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $66.07 / $331.13	Facility	TC	$33.88	$66.07	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $41.69 / $117.49	Professional		$26.30	$41.69	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.75 / $37.15	Professional	26	$7.08	$11.75	$37.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.84 / $56.23	Professional	TC	$19.05	$28.84	$56.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $239.88 / $302.00	Facility		$26.92	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $60.26 / $93.33	Professional		$30.20	$60.26	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.49 / $24.55	Professional	26	$8.91	$15.49	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $43.65 / $69.18	Professional	TC	$22.39	$43.65	$69.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $69.18 / $89.13	Professional		$61.66	$69.18	$89.13
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 $45.71 / $51.29 / $67.61	Professional	TC	$45.71	$51.29	$67.61
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $51.29 / $147.91	Facility		$30.20	$51.29	$147.91
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $16.22 / $33.11	Facility	26	$11.48	$16.22	$33.11
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $33.11 / $66.07 / $331.13	Facility	TC	$33.11	$66.07	$331.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $57.54 / $97.72	Professional		$33.88	$57.54	$97.72
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $16.98 / $25.12	Professional	26	$8.51	$16.98	$25.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $45.71 / $67.61	Professional	TC	$23.99	$45.71	$67.61
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $58.88 / $66.07	Facility		$42.66	$58.88	$66.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.60	Facility	26	$13.80	$16.60	$16.60
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $41.69 / $48.98	Facility	TC	$30.90	$41.69	$48.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $30.90 / $30.90	Professional		$30.90	$30.90	$30.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $17.78	Professional	26	$10.00	$14.13	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.88 / $47.86	Professional	TC	$25.12	$33.88	$47.86
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $48.98 / $83.18	Facility		$31.62	$48.98	$83.18
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 $5.62 / $26.30 / $38.02	Facility	TC	$5.62	$26.30	$38.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $64.57 / $93.33	Professional		$48.98	$64.57	$93.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.38 / $24.55	Professional	26	$11.48	$17.38	$24.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $44.67 / $69.18	Professional	TC	$28.84	$44.67	$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 $53.70 / $67.61 / $87.10	Professional		$53.70	$67.61	$87.10
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 $36.31 / $48.98 / $64.57	Professional	TC	$36.31	$48.98	$64.57
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 $28.18 / $38.02 / $85.11	Professional		$28.18	$38.02	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.47 / $23.44	Professional	26	$8.32	$10.47	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $27.54 / $63.10	Professional	TC	$19.50	$27.54	$63.10