Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.63 / $231.00 / $407.40	Facility		$61.63	$231.00	$407.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $18.12 / $42.65	Facility	26	$11.63	$18.12	$42.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $53.94 / $179.24 / $418.00	Facility	TC	$53.94	$179.24	$418.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.96 / $49.84 / $167.00	Professional		$18.96	$49.84	$167.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $15.46 / $44.09	Professional	26	$8.13	$15.46	$44.09
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.85 / $17.85 / $44.56	Professional	50	$17.85	$17.85	$44.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $48.27 / $132.00	Professional	TC	$25.37	$48.27	$132.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.81 / $223.86 / $304.19	Facility		$35.81	$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 $36.90 / $36.90 / $36.90	Facility	TC	$36.90	$36.90	$36.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.27 / $72.00 / $114.87	Professional		$38.27	$72.00	$114.87
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 $29.13 / $58.01 / $92.96	Professional	TC	$29.13	$58.01	$92.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.61 / $97.25 / $112.89	Professional		$81.61	$97.25	$112.89
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 $65.16 / $77.81 / $91.36	Professional	TC	$65.16	$77.81	$91.36
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.89 / $71.40 / $121.54	Facility		$35.89	$71.40	$121.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.50 / $70.19 / $122.44	Professional		$56.50	$70.19	$122.44
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 $42.24 / $64.03 / $99.63	Professional	TC	$42.24	$64.03	$99.63
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $48.51 / $71.15 / $83.08	Facility		$48.51	$71.15	$83.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.25 / $16.75	Facility	26	$12.25	$16.25	$16.75
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $36.34 / $56.08 / $66.33	Facility	TC	$36.34	$56.08	$66.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.25 / $18.05	Professional	26	$10.00	$14.25	$18.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.36 / $45.00 / $60.69	Professional	TC	$33.36	$45.00	$60.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $39.54 / $86.70 / $121.54	Facility		$39.54	$86.70	$121.54
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 $36.90 / $36.90 / $36.90	Facility	TC	$36.90	$36.90	$36.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.36 / $86.80 / $115.90	Professional		$59.36	$86.80	$115.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.33 / $16.77 / $24.58	Professional	26	$11.33	$16.77	$24.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.78 / $63.50 / $92.96	Professional	TC	$38.78	$63.50	$92.96
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 $68.88 / $84.94 / $111.91	Professional		$68.88	$84.94	$111.91
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 $53.51 / $67.81 / $89.16	Professional	TC	$53.51	$67.81	$89.16
United Facility/Professional Professional Modifier Low / Median / High Price $35.57 / $42.56 / $112.67	Professional		$35.57	$42.56	$112.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $9.75 / $25.83	Professional	26	$8.94	$9.75	$25.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.23 / $31.97 / $86.70	Professional	TC	$26.23	$31.97	$86.70