Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $245.47 / $407.38	Facility		$67.61	$245.47	$407.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $19.05 / $72.44	Facility	26	$11.48	$19.05	$72.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $45.71 / $177.83 / $416.87	Facility	TC	$45.71	$177.83	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $52.48 / $144.54	Professional		$12.30	$52.48	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $15.49 / $44.67	Professional	26	$7.94	$15.49	$44.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.20 / $95.50 / $213.80	Professional	50	$18.20	$95.50	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $52.48 / $95.50	Professional	TC	$25.70	$52.48	$95.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $239.88 / $302.00	Facility		$35.48	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $75.86 / $117.49	Professional		$34.67	$75.86	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.85 / $24.55	Professional	26	$8.91	$15.85	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $58.88 / $95.50	Professional	TC	$27.54	$58.88	$95.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $91.20 / $112.20	Professional		$83.18	$91.20	$112.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $18.62 / $21.88	Professional	26	$16.60	$18.62	$21.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $74.13 / $91.20	Professional	TC	$66.07	$74.13	$91.20
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $79.43 / $338.84	Facility		$39.81	$79.43	$338.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $16.98 / $42.66	Facility	26	$11.48	$16.98	$42.66
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $44.67 / $169.82 / $446.68	Facility	TC	$44.67	$169.82	$446.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $67.61 / $123.03	Professional		$21.88	$67.61	$123.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $16.60 / $27.54	Professional	26	$8.71	$16.60	$27.54
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $20.42 / $109.65 / $302.00	Professional	50	$20.42	$109.65	$302.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $61.66 / $95.50	Professional	TC	$31.62	$61.66	$95.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $72.44 / $83.18	Facility		$51.29	$72.44	$83.18
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 $39.81 / $56.23 / $66.07	Facility	TC	$39.81	$56.23	$66.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $36.31 / $36.31	Professional		$36.31	$36.31	$36.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $17.78	Professional	26	$10.00	$14.79	$17.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $46.77 / $57.54	Professional	TC	$33.88	$46.77	$57.54
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $60.26 / $100.00	Facility		$36.31	$60.26	$100.00
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 $7.76 / $35.48 / $51.29	Facility	TC	$7.76	$35.48	$51.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $81.28 / $117.49	Professional		$61.66	$81.28	$117.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.38 / $24.55	Professional	26	$11.75	$17.38	$24.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $95.50	Professional	TC	$37.15	$61.66	$95.50
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 $67.61 / $81.28 / $107.15	Professional		$67.61	$81.28	$107.15
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 $50.12 / $63.10 / $87.10	Professional	TC	$50.12	$63.10	$87.10
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 $35.48 / $42.66 / $107.15	Professional		$35.48	$42.66	$107.15
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 $25.70 / $33.11 / $85.11	Professional	TC	$25.70	$33.11	$85.11