Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.26 / $141.08 / $350.20	Facility		$40.26	$141.08	$350.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.28 / $18.05 / $40.54	Facility	26	$11.28	$18.05	$40.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.15 / $60.21 / $313.50	Facility	TC	$36.15	$60.21	$313.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.32 / $41.00 / $139.00	Professional		$19.32	$41.00	$139.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $12.35 / $41.00	Professional	26	$7.66	$12.35	$41.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.88 / $120.00 / $120.00	Professional	50	$52.88	$120.00	$120.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.28 / $17.48 / $94.43	Professional	52	$11.28	$17.48	$94.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $28.96 / $71.66	Professional	TC	$20.07	$28.96	$71.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.47 / $223.86 / $304.19	Facility		$28.47	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
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 $32.64 / $62.08 / $93.80	Professional		$32.64	$62.08	$93.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.32 / $16.21 / $23.60	Professional	26	$9.32	$16.21	$23.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.63 / $46.12 / $72.23	Professional	TC	$23.63	$46.12	$72.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.41 / $79.08 / $91.65	Professional		$66.41	$79.08	$91.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $18.36 / $20.67	Professional	26	$15.31	$18.36	$20.67
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 $28.37 / $56.51 / $90.71	Facility		$28.37	$56.51	$90.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $57.17 / $103.68	Professional		$49.00	$57.17	$103.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $15.52 / $24.39	Professional	26	$12.80	$15.52	$24.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.64 / $50.32 / $79.29	Professional	TC	$35.64	$50.32	$79.29
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $59.70 / $68.34	Facility		$40.00	$59.70	$68.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.78 / $16.32	Facility	26	$11.76	$15.78	$16.32
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $31.85 / $45.22 / $52.26	Facility	TC	$31.85	$45.22	$52.26
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $14.47 / $17.88	Professional	26	$10.45	$14.47	$17.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $26.46 / $36.45 / $46.43	Professional	TC	$26.46	$36.45	$46.43
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.81 / $71.40 / $101.74	Facility		$33.81	$71.40	$101.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
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 $51.11 / $72.47 / $96.90	Professional		$51.11	$72.47	$96.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.87 / $16.63 / $23.60	Professional	26	$10.87	$16.63	$23.60
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $37.28 / $39.11 / $39.11	Professional	52	$37.28	$39.11	$39.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.08 / $51.14 / $73.14	Professional	TC	$31.08	$51.14	$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 $58.56 / $70.69 / $92.80	Professional		$58.56	$70.69	$92.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $17.10 / $22.74	Professional	26	$14.36	$17.10	$22.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.44 / $53.43 / $70.95	Professional	TC	$42.44	$53.43	$70.95
United Facility/Professional Professional Modifier Low / Median / High Price $29.47 / $38.36 / $95.08	Professional		$29.47	$38.36	$95.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.59 / $10.71 / $25.52	Professional	26	$8.59	$10.71	$25.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.49 / $26.52 / $70.17	Professional	TC	$20.49	$26.52	$70.17