Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $281.84 / $398.11	Facility		$63.10	$281.84	$398.11
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 $41.69 / $186.21 / $302.00	Facility	TC	$41.69	$186.21	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $42.66 / $125.89	Professional		$11.75	$42.66	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.30 / $37.15	Professional	26	$7.94	$12.30	$37.15
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.67 / $85.11 / $177.83	Professional	50	$34.67	$85.11	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $40.74 / $70.79	Professional	TC	$19.95	$40.74	$70.79
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 $33.88 / $63.10 / $97.72	Professional		$33.88	$63.10	$97.72
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 $25.12 / $47.86 / $72.44	Professional	TC	$25.12	$47.86	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $70.79 / $89.13	Professional		$63.10	$70.79	$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 $47.86 / $53.70 / $67.61	Professional	TC	$47.86	$53.70	$67.61
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $61.66 / $323.59	Facility		$32.36	$61.66	$323.59
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $16.98 / $38.90	Facility	26	$11.48	$16.98	$38.90
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $40.74 / $234.42 / $302.00	Facility	TC	$40.74	$234.42	$302.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $54.95 / $93.33	Professional		$20.42	$54.95	$93.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.85 / $26.30	Professional	26	$8.71	$15.85	$26.30
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $20.42 / $79.43 / $87.10	Professional	50	$20.42	$79.43	$87.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $47.86 / $67.61	Professional	TC	$26.92	$47.86	$67.61
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $60.26 / $66.07	Facility		$48.98	$60.26	$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 $36.31 / $43.65 / $50.12	Facility	TC	$36.31	$43.65	$50.12
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Professional		$38.02	$38.02	$38.02
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.45 / $18.20	Professional	26	$10.00	$14.45	$18.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $40.74 / $50.12	Professional	TC	$26.92	$40.74	$50.12
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $51.29 / $83.18	Facility		$32.36	$51.29	$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 $51.29 / $67.61 / $95.50	Professional		$51.29	$67.61	$95.50
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 $33.11 / $48.98 / $72.44	Professional	TC	$33.11	$48.98	$72.44
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 / $66.07 / $87.10	Professional		$56.23	$66.07	$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 $41.69 / $47.86 / $64.57	Professional	TC	$41.69	$47.86	$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 $31.62 / $38.02 / $87.10	Professional		$31.62	$38.02	$87.10
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 $22.39 / $28.18 / $64.57	Professional	TC	$22.39	$28.18	$64.57