Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.68 / $165.40 / $425.92	Facility		$45.68	$165.40	$425.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.90 / $23.31 / $53.20	Facility	26	$14.90	$23.31	$53.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $43.93 / $68.48 / $325.92	Facility	TC	$43.93	$68.48	$325.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $49.46 / $163.12	Professional		$35.95	$49.46	$163.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.36 / $14.42 / $30.07	Professional	26	$10.36	$14.42	$30.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.28 / $38.28 / $38.29	Professional	50	$38.28	$38.28	$38.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.86 / $31.51 / $76.70	Professional	TC	$24.86	$31.51	$76.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.60 / $301.52 / $367.38	Facility		$33.60	$301.52	$367.38
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 $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.37 / $78.06 / $114.48	Professional		$42.37	$78.06	$114.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.73 / $21.04 / $31.10	Professional	26	$12.73	$21.04	$31.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.38 / $55.14 / $86.37	Professional	TC	$30.38	$55.14	$86.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.67 / $97.13 / $112.50	Professional		$81.67	$97.13	$112.50
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 $60.54 / $72.29 / $84.87	Professional	TC	$60.54	$72.29	$84.87
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $33.52 / $67.16 / $106.46	Facility		$33.52	$67.16	$106.46
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $62.72 / $75.59 / $126.06	Professional		$62.72	$75.59	$126.06
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 $49.10 / $63.85 / $93.54	Professional	TC	$49.10	$63.85	$93.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $52.53 / $76.19 / $83.08	Facility		$52.53	$76.19	$83.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.99 / $21.12 / $22.11	Facility	26	$15.99	$21.12	$22.11
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $38.28 / $55.67 / $61.64	Facility	TC	$38.28	$55.67	$61.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $17.59 / $23.76	Professional	26	$12.86	$17.59	$23.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.18 / $50.60 / $61.64	Professional	TC	$33.18	$50.60	$61.64
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.93 / $96.28 / $130.19	Facility		$41.93	$96.28	$130.19
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 $34.29 / $34.29 / $34.29	Facility	TC	$34.29	$34.29	$34.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.47 / $89.18 / $117.91	Professional		$64.47	$89.18	$117.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.50 / $22.35 / $31.47	Professional	26	$14.50	$22.35	$31.47
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $45.18 / $47.63 / $47.63	Professional	52	$45.18	$47.63	$47.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.78 / $60.07 / $86.37	Professional	TC	$38.78	$60.07	$86.37
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 $68.26 / $86.18 / $112.82	Professional		$68.26	$86.18	$112.82
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 $47.97 / $63.02 / $83.70	Professional	TC	$47.97	$63.02	$83.70
United Facility/Professional Professional Modifier Low / Median / High Price $39.89 / $49.73 / $115.76	Professional		$39.89	$49.73	$115.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $12.44 / $33.03	Professional	26	$10.97	$12.44	$33.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.03 / $33.86 / $82.68	Professional	TC	$28.03	$33.86	$82.68