Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.03 / $271.68 / $543.36	Facility		$53.03	$271.68	$543.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $16.85 / $42.22	Facility	26	$11.63	$16.85	$42.22
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $46.94 / $226.19 / $453.28	Facility	TC	$46.94	$226.19	$453.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.00 / $42.76 / $140.00	Professional		$15.00	$42.76	$140.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $14.25 / $47.30	Professional	26	$7.78	$14.25	$47.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $16.52 / $64.50 / $165.73	Professional	50	$16.52	$64.50	$165.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $42.69 / $121.00	Professional	TC	$21.64	$42.69	$121.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.40 / $223.86 / $304.19	Facility		$31.40	$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 $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.76 / $64.87 / $103.56	Professional		$32.76	$64.87	$103.56
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 $25.46 / $50.56 / $81.65	Professional	TC	$25.46	$50.56	$81.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $73.70 / $87.76 / $101.77	Professional		$73.70	$87.76	$101.77
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 $57.25 / $68.36 / $80.25	Professional	TC	$57.25	$68.36	$80.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.07 / $62.78 / $108.36	Facility		$32.07	$62.78	$108.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.49 / $63.40 / $112.83	Professional		$50.49	$63.40	$112.83
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 $38.94 / $56.27 / $87.42	Professional	TC	$38.94	$56.27	$87.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.00 / $62.98 / $75.04	Facility		$44.00	$62.98	$75.04
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 $33.74 / $48.84 / $58.29	Facility	TC	$33.74	$48.84	$58.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.50 / $14.25 / $17.19	Professional	26	$10.50	$14.25	$17.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.74 / $39.53 / $50.40	Professional	TC	$27.74	$39.53	$50.40
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.72 / $75.65 / $109.01	Facility		$36.72	$75.65	$109.01
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 $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.55 / $76.83 / $103.56	Professional		$53.55	$76.83	$103.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $16.77 / $24.58	Professional	26	$11.25	$16.77	$24.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.49 / $55.26 / $81.65	Professional	TC	$33.49	$55.26	$81.65
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 $60.16 / $76.72 / $100.99	Professional		$60.16	$76.72	$100.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $17.69 / $23.69	Professional	26	$14.96	$17.69	$23.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.28 / $59.29 / $78.23	Professional	TC	$44.28	$59.29	$78.23
United Facility/Professional Professional Modifier Low / Median / High Price $30.70 / $39.90 / $101.30	Professional		$30.70	$39.90	$101.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.96 / $9.99 / $25.83	Professional	26	$8.96	$9.99	$25.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.56 / $43.39 / $75.47	Professional	TC	$21.56	$43.39	$75.47