Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $257.04 / $416.87	Facility		$63.10	$257.04	$416.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $19.50 / $75.86	Facility	26	$12.59	$19.50	$75.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $177.83 / $338.84	Facility	TC	$35.48	$177.83	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $43.65 / $120.23	Professional		$14.13	$43.65	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.49 / $42.66	Professional	26	$8.51	$13.49	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.11 / $79.43 / $181.97	Professional	50	$33.11	$79.43	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $39.81 / $91.20	Professional	TC	$20.89	$39.81	$91.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $239.88 / $302.00	Facility		$28.18	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $63.10 / $97.72	Professional		$30.90	$63.10	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $17.38 / $27.54	Professional	26	$10.00	$17.38	$27.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $45.71 / $74.13	Professional	TC	$22.39	$45.71	$74.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $77.62 / $93.33	Professional		$69.18	$77.62	$93.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $19.50 / $23.44	Professional	26	$17.38	$19.50	$23.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $57.54 / $72.44	Professional	TC	$51.29	$57.54	$72.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $70.79 / $346.74	Facility		$35.48	$70.79	$346.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $15.49 / $26.92	Facility	26	$12.59	$15.49	$26.92
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $35.48 / $186.21 / $512.86	Facility	TC	$35.48	$186.21	$512.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $56.23 / $102.33	Professional		$28.18	$56.23	$102.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $16.98 / $29.51	Professional	26	$9.12	$16.98	$29.51
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $19.05 / $77.62 / $208.93	Professional	50	$19.05	$77.62	$208.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $48.98 / $75.86	Professional	TC	$25.70	$48.98	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $61.66 / $70.79	Facility		$44.67	$61.66	$70.79
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $17.78 / $18.20	Facility	26	$14.79	$17.78	$18.20
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $31.62 / $43.65 / $52.48	Facility	TC	$31.62	$43.65	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $19.95	Professional	26	$10.96	$16.22	$19.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.88 / $46.77	Professional	TC	$25.12	$33.88	$46.77
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $52.48 / $89.13	Facility		$33.11	$52.48	$89.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.03 / $28.18 / $39.81	Facility	TC	$6.03	$28.18	$39.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $100.00	Professional		$51.29	$67.61	$100.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.05 / $26.30	Professional	26	$12.88	$19.05	$26.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $45.71 / $74.13	Professional	TC	$28.84	$45.71	$74.13
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 $56.23 / $69.18 / $91.20	Professional		$56.23	$69.18	$91.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $19.05 / $24.55	Professional	26	$16.22	$19.05	$24.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $48.98 / $67.61	Professional	TC	$36.31	$48.98	$67.61
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 $28.84 / $38.90 / $91.20	Professional		$28.84	$38.90	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.22 / $25.12	Professional	26	$8.71	$11.22	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $27.54 / $67.61	Professional	TC	$19.95	$27.54	$67.61