Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.85 / $222.30 / $359.22	Facility		$41.85	$222.30	$359.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.69 / $16.66 / $38.76	Facility	26	$10.69	$16.66	$38.76
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.85 / $116.23 / $292.22	Facility	TC	$35.85	$116.23	$292.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.27 / $36.61 / $132.54	Professional		$17.27	$36.61	$132.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.31 / $42.00	Professional	26	$7.03	$11.31	$42.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $29.80 / $57.92	Professional	TC	$18.21	$29.80	$57.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.70 / $223.86 / $304.19	Facility		$23.70	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.53 / $53.18 / $81.01	Professional		$28.53	$53.18	$81.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $15.54 / $23.13	Professional	26	$8.55	$15.54	$23.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.59 / $38.39 / $60.92	Professional	TC	$20.59	$38.39	$60.92
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.83 / $68.81 / $79.59	Professional		$57.83	$68.81	$79.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.67 / $17.55 / $19.76	Professional	26	$14.67	$17.55	$19.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.71 / $51.00 / $59.87	Professional	TC	$42.71	$51.00	$59.87
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $25.58 / $51.75 / $76.81	Facility		$25.58	$51.75	$76.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $43.80 / $49.81 / $89.46	Professional		$43.80	$49.81	$89.46
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $15.70 / $23.37	Professional	26	$12.28	$15.70	$23.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.70 / $45.41 / $66.09	Professional	TC	$34.70	$45.41	$66.09
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $35.36 / $52.93 / $58.96	Facility		$35.36	$52.93	$58.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.11 / $16.07	Facility	26	$11.76	$15.11	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $27.93 / $37.52 / $43.55	Facility	TC	$27.93	$37.52	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.68 / $13.92 / $16.50	Professional	26	$9.68	$13.92	$16.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $31.89 / $39.53	Professional	TC	$22.51	$31.89	$39.53
Providence Facility/Professional Facility Modifier Low / Median / High Price $30.47 / $63.00 / $87.12	Facility		$30.47	$63.00	$87.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $43.43 / $62.42 / $83.52	Professional		$43.43	$62.42	$83.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $15.93 / $23.14	Professional	26	$10.42	$15.93	$23.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.34 / $42.22 / $60.92	Professional	TC	$26.34	$42.22	$60.92
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 $51.05 / $61.16 / $80.06	Professional		$51.05	$61.16	$80.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.77 / $16.98 / $21.79	Professional	26	$13.77	$16.98	$21.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.60 / $44.53 / $59.14	Professional	TC	$36.60	$44.53	$59.14
United Facility/Professional Professional Modifier Low / Median / High Price $25.87 / $35.15 / $84.99	Professional		$25.87	$35.15	$84.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $9.86 / $24.58	Professional	26	$8.23	$9.86	$24.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.59 / $25.96 / $69.16	Professional	TC	$17.59	$25.96	$69.16