Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $234.42 / $489.78	Facility		$77.62	$234.42	$489.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $25.12 / $72.44	Facility	26	$14.79	$25.12	$72.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $60.26 / $199.53 / $602.56	Facility	TC	$60.26	$199.53	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $53.70 / $147.91	Professional		$15.14	$53.70	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.14 / $47.86	Professional	26	$9.33	$15.14	$47.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $52.48 / $158.49	Professional	50	$40.74	$52.48	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $53.70 / $93.33	Professional	TC	$28.18	$53.70	$93.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $239.88 / $302.00	Facility		$39.81	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $89.13 / $134.90	Professional		$42.66	$89.13	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.95 / $31.62	Professional	26	$12.02	$19.95	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $67.61 / $107.15	Professional	TC	$32.36	$67.61	$107.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $104.71 / $128.82	Professional		$93.33	$104.71	$128.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $22.91 / $27.54	Professional	26	$20.42	$22.91	$27.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $81.28 / $102.33	Professional	TC	$74.13	$81.28	$102.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $100.00 / $398.11	Facility		$43.65	$100.00	$398.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.88 / $42.66	Facility	26	$14.79	$21.88	$42.66
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $54.95 / $229.09 / $616.60	Facility	TC	$54.95	$229.09	$616.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $83.18 / $141.25	Professional		$26.92	$83.18	$141.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $21.38 / $33.88	Professional	26	$10.72	$21.38	$33.88
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $26.30 / $52.48 / $158.49	Professional	50	$26.30	$52.48	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $72.44 / $109.65	Professional	TC	$34.67	$72.44	$109.65
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $87.10 / $95.50	Facility		$66.07	$87.10	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.38	Facility	26	$17.78	$20.89	$21.38
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $48.98 / $67.61 / $74.13	Facility	TC	$48.98	$67.61	$74.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $17.78 / $22.91	Professional	26	$12.59	$17.78	$22.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $61.66 / $72.44	Professional	TC	$38.90	$61.66	$72.44
Providence Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $66.07 / $128.82	Facility		$40.74	$66.07	$128.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $8.71 / $39.81 / $57.54	Facility	TC	$8.71	$39.81	$57.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $100.00 / $138.04	Professional		$70.79	$100.00	$138.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $22.39 / $31.62	Professional	26	$14.45	$22.39	$31.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $74.13 / $109.65	Professional	TC	$42.66	$74.13	$109.65
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 $70.79 / $95.50 / $123.03	Professional		$70.79	$95.50	$123.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.39 / $29.51	Professional	26	$19.50	$22.39	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $72.44 / $95.50	Professional	TC	$52.48	$72.44	$95.50
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 $41.69 / $53.70 / $125.89	Professional		$41.69	$53.70	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.45 / $29.51	Professional	26	$11.22	$14.45	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $39.81 / $97.72	Professional	TC	$30.20	$39.81	$97.72