Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $73.86 / $195.63 / $428.35	Facility		$73.86	$195.63	$428.35
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.90 / $23.31 / $54.20	Facility	26	$14.90	$23.31	$54.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $60.34 / $195.63 / $544.89	Facility	TC	$60.34	$195.63	$544.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.54 / $54.48 / $170.86	Professional		$15.54	$54.48	$170.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $14.90 / $48.00	Professional	26	$10.02	$14.90	$48.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $50.29 / $132.80	Professional	TC	$27.55	$50.29	$132.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.84 / $223.86 / $304.19	Facility		$39.84	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.18 / $82.53 / $132.38	Professional		$45.18	$82.53	$132.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $21.04 / $30.97	Professional	26	$12.37	$21.04	$30.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.82 / $64.55 / $104.28	Professional	TC	$32.82	$64.55	$104.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $94.22 / $112.15 / $130.10	Professional		$94.22	$112.15	$130.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $24.54 / $27.62	Professional	26	$20.48	$24.54	$27.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.09 / $87.28 / $102.47	Professional	TC	$73.09	$87.28	$102.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.47 / $77.67 / $140.16	Facility		$38.47	$77.67	$140.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $68.44 / $84.37 / $143.34	Professional		$68.44	$84.37	$143.34
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $22.22 / $32.52	Professional	26	$17.07	$22.22	$32.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.24 / $78.26 / $110.82	Professional	TC	$59.24	$78.26	$110.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $56.84 / $85.09 / $95.81	Facility		$56.84	$85.09	$95.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.50 / $21.12 / $21.44	Facility	26	$15.50	$21.12	$21.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.32 / $64.03 / $74.37	Facility	TC	$44.32	$64.03	$74.37
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $17.60 / $22.56	Professional	26	$12.86	$17.60	$22.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $39.86 / $61.04 / $74.37	Professional	TC	$39.86	$61.04	$74.37
Providence Facility/Professional Facility Modifier Low / Median / High Price $45.49 / $108.42 / $148.05	Facility		$45.49	$108.42	$148.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $41.38 / $41.38 / $41.38	Facility	TC	$41.38	$41.38	$41.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $68.44 / $100.82 / $135.80	Professional		$68.44	$100.82	$135.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $21.86 / $31.47	Professional	26	$14.36	$21.86	$31.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.57 / $71.05 / $104.28	Professional	TC	$44.57	$71.05	$104.28
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 $71.34 / $98.46 / $128.28	Professional		$71.34	$98.46	$128.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $22.74 / $30.32	Professional	26	$19.14	$22.74	$30.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.97 / $76.04 / $99.17	Professional	TC	$51.97	$76.04	$99.17
United Facility/Professional Professional Modifier Low / Median / High Price $41.68 / $51.97 / $131.26	Professional		$41.68	$51.97	$131.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.46 / $15.36 / $33.08	Professional	26	$11.46	$15.36	$33.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.18 / $41.38 / $98.18	Professional	TC	$30.18	$41.38	$98.18