Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.61 / $238.00 / $376.15	Facility		$46.61	$238.00	$376.15
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $16.85 / $39.07	Facility	26	$11.63	$16.85	$39.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.94 / $169.80 / $302.68	Facility	TC	$40.94	$169.80	$302.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.98 / $39.92 / $134.10	Professional		$17.98	$39.92	$134.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $11.75 / $38.00	Professional	26	$7.61	$11.75	$38.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.14 / $79.14 / $79.14	Professional	50	$79.14	$79.14	$79.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $33.29 / $70.34	Professional	TC	$23.51	$33.29	$70.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.63 / $223.86 / $304.19	Facility		$26.63	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $63.39 / $91.27	Professional		$34.67	$63.39	$91.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $16.37 / $24.12	Professional	26	$9.31	$16.37	$24.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.18 / $46.99 / $69.37	Professional	TC	$25.18	$46.99	$69.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.44 / $76.69 / $88.79	Professional		$64.44	$76.69	$88.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $19.12 / $21.52	Professional	26	$15.96	$19.12	$21.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.99 / $57.30 / $67.27	Professional	TC	$47.99	$57.30	$67.27
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $29.07 / $58.57 / $93.49	Facility		$29.07	$58.57	$93.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $47.04 / $55.48 / $97.35	Professional		$47.04	$55.48	$97.35
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $16.18 / $25.41	Professional	26	$13.35	$16.18	$25.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.96 / $51.37 / $74.22	Professional	TC	$38.96	$51.37	$74.22
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $42.63 / $59.31 / $66.33	Facility		$42.63	$59.31	$66.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.11 / $16.25 / $16.75	Facility	26	$12.11	$16.25	$16.75
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $35.31 / $44.11 / $49.58	Facility	TC	$35.31	$44.11	$49.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.05 / $14.50 / $18.50	Professional	26	$10.05	$14.50	$18.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.05 / $41.54 / $49.77	Professional	TC	$26.05	$41.54	$49.77
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.76 / $75.12 / $98.70	Facility		$33.76	$75.12	$98.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.33 / $69.84 / $92.36	Professional		$51.33	$69.84	$92.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $16.77 / $24.58	Professional	26	$11.25	$16.77	$24.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.61 / $48.44 / $69.37	Professional	TC	$32.61	$48.44	$69.37
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 $58.65 / $67.81 / $89.16	Professional		$58.65	$67.81	$89.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $17.77 / $23.69	Professional	26	$14.96	$17.77	$23.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.26 / $50.51 / $66.42	Professional	TC	$42.26	$50.51	$66.42
United Facility/Professional Professional Modifier Low / Median / High Price $31.40 / $38.09 / $89.93	Professional		$31.40	$38.09	$89.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $11.17 / $25.79	Professional	26	$8.94	$11.17	$25.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.28 / $29.56 / $64.51	Professional	TC	$22.28	$29.56	$64.51