Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.99 / $259.14 / $432.59	Facility		$56.99	$259.14	$432.59
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.53 / $17.87 / $45.74	Facility	26	$12.53	$17.87	$45.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.52 / $185.28 / $510.94	Facility	TC	$37.52	$185.28	$510.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.63 / $44.00 / $123.14	Professional		$16.63	$44.00	$123.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $12.94 / $44.52	Professional	26	$8.56	$12.94	$44.52
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.86 / $33.27 / $113.04	Professional	50	$17.86	$33.27	$113.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $38.29 / $104.00	Professional	TC	$19.14	$38.29	$104.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.10 / $223.86 / $304.19	Facility		$28.10	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.28 / $60.67 / $95.94	Professional		$32.28	$60.67	$95.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $17.72 / $26.24	Professional	26	$10.47	$17.72	$26.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.05 / $43.76 / $72.23	Professional	TC	$23.05	$43.76	$72.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.42 / $81.41 / $94.27	Professional		$68.42	$81.41	$94.27
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $20.68 / $23.29	Professional	26	$17.23	$20.68	$23.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.64 / $60.47 / $70.98	Professional	TC	$50.64	$60.47	$70.98
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $30.84 / $62.36 / $102.71	Facility		$30.84	$62.36	$102.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $47.60 / $58.87 / $103.39	Professional		$47.60	$58.87	$103.39
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $17.46 / $27.45	Professional	26	$14.40	$17.46	$27.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.70 / $47.83 / $78.27	Professional	TC	$37.70	$47.83	$78.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $59.63 / $70.34	Facility		$40.00	$59.63	$70.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.23 / $17.78 / $18.36	Facility	26	$13.23	$17.78	$18.36
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.38 / $43.52 / $52.26	Facility	TC	$30.38	$43.52	$52.26
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.66 / $16.53 / $19.80	Professional	26	$11.66	$16.53	$19.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.80 / $35.34 / $44.42	Professional	TC	$25.80	$35.34	$44.42
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.46 / $70.55 / $104.69	Facility		$34.46	$70.55	$104.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.08 / $29.08 / $29.08	Facility	TC	$29.08	$29.08	$29.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.62 / $72.02 / $97.85	Professional		$49.62	$72.02	$97.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $18.37 / $26.55	Professional	26	$12.23	$18.37	$26.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.63 / $49.77 / $73.14	Professional	TC	$29.63	$49.77	$73.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $201.89 / $281.32 / $339.89	Facility		$201.89	$281.32	$339.89
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 $57.19 / $71.93 / $94.62	Professional		$57.19	$71.93	$94.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $19.19 / $25.58	Professional	26	$16.16	$19.19	$25.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.36 / $52.49 / $70.05	Professional	TC	$39.36	$52.49	$70.05
United Facility/Professional Professional Modifier Low / Median / High Price $29.11 / $39.97 / $96.12	Professional		$29.11	$39.97	$96.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $12.07 / $27.86	Professional	26	$9.38	$12.07	$27.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.73 / $31.15 / $67.98	Professional	TC	$19.73	$31.15	$67.98