Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.72 / $118.72 / $365.40	Facility		$44.72	$118.72	$365.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.28 / $17.37 / $40.13	Facility	26	$11.28	$17.37	$40.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.43 / $53.90 / $295.20	Facility	TC	$33.43	$53.90	$295.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.26 / $40.78 / $174.26	Professional		$20.26	$40.78	$174.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.86 / $46.55	Professional	26	$7.03	$11.86	$46.55
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.52 / $73.37 / $73.37	Professional	50	$47.52	$73.37	$73.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.13 / $18.73 / $169.66	Professional	52	$10.13	$18.73	$169.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $26.00 / $65.20	Professional	TC	$17.89	$26.00	$65.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $25.53 / $301.52 / $367.38	Facility		$25.53	$301.52	$367.38
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 $26.47 / $26.47 / $26.47	Facility	TC	$26.47	$26.47	$26.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.29 / $54.87 / $86.67	Professional		$28.29	$54.87	$86.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $15.71 / $23.14	Professional	26	$8.61	$15.71	$23.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.06 / $41.36 / $65.63	Professional	TC	$21.06	$41.36	$65.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.79 / $73.56 / $85.16	Professional		$61.79	$73.56	$85.16
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 $46.00 / $54.93 / $64.48	Professional	TC	$46.00	$54.93	$64.48
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $27.35 / $51.84 / $76.81	Facility		$27.35	$51.84	$76.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.26 / $53.22 / $95.55	Professional		$45.26	$53.22	$95.55
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 $34.32 / $45.92 / $71.16	Professional	TC	$34.32	$45.92	$71.16
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $36.00 / $53.01 / $63.65	Facility		$36.00	$53.01	$63.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $15.60 / $16.07	Facility	26	$11.63	$15.60	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $28.42 / $40.40 / $47.57	Facility	TC	$28.42	$40.40	$47.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $13.68 / $16.92	Professional	26	$9.65	$13.68	$16.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $31.27 / $47.38	Professional	TC	$22.11	$31.27	$47.38
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.14 / $63.91 / $94.72	Facility		$31.14	$63.91	$94.72
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 $26.47 / $26.47 / $26.47	Facility	TC	$26.47	$26.47	$26.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.88 / $64.84 / $88.35	Professional		$45.88	$64.84	$88.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.81 / $15.93 / $23.60	Professional	26	$10.81	$15.93	$23.60
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $34.26 / $36.01 / $36.01	Professional	52	$34.26	$36.01	$36.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.58 / $45.65 / $66.55	Professional	TC	$28.58	$45.65	$66.55
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $51.24 / $65.08 / $85.52	Professional		$51.24	$65.08	$85.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $16.98 / $22.74	Professional	26	$14.36	$16.98	$22.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.60 / $48.64 / $63.69	Professional	TC	$36.60	$48.64	$63.69
United Facility/Professional Professional Modifier Low / Median / High Price $26.56 / $35.47 / $87.73	Professional		$26.56	$35.47	$87.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $9.59 / $24.76	Professional	26	$8.23	$9.59	$24.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.95 / $28.62 / $63.06	Professional	TC	$17.95	$28.62	$63.06