Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $177.83 / $524.81	Facility		$63.10	$177.83	$524.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $25.12 / $29.51	Facility	26	$14.79	$25.12	$29.51
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $51.29 / $83.18 / $446.68	Facility	TC	$51.29	$83.18	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $54.95 / $147.91	Professional		$34.67	$54.95	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.79 / $32.36	Professional	26	$9.12	$14.79	$32.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $38.02 / $123.03	Professional	50	$38.02	$38.02	$123.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	52	$72.44	$72.44	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $77.62	Professional	TC	$23.99	$33.88	$77.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $302.00 / $371.54	Facility		$33.88	$302.00	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $79.43 / $117.49	Professional		$41.69	$79.43	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $20.42 / $31.62	Professional	26	$12.30	$20.42	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $89.13	Professional	TC	$30.20	$57.54	$89.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $112.20	Professional		$81.28	$91.20	$112.20
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 $60.26 / $67.61 / $85.11	Professional	TC	$60.26	$67.61	$85.11
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $64.57 / $316.23	Facility		$33.88	$64.57	$316.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $21.88 / $47.86	Facility	26	$14.79	$21.88	$47.86
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $42.66 / $64.57 / $446.68	Facility	TC	$42.66	$64.57	$446.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $75.86 / $123.03	Professional		$41.69	$75.86	$123.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $20.42 / $31.62	Professional	26	$11.48	$20.42	$31.62
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $26.92 / $38.02 / $147.91	Professional	50	$26.92	$38.02	$147.91
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	52	$72.44	$72.44	$72.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $60.26 / $91.20	Professional	TC	$30.20	$60.26	$91.20
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $75.86 / $83.18	Facility		$57.54	$75.86	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $20.89 / $21.88	Facility	26	$17.78	$20.89	$21.88
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $44.67 / $56.23 / $61.66	Facility	TC	$44.67	$56.23	$61.66
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $17.78 / $22.91	Professional	26	$13.18	$17.78	$22.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.29 / $60.26	Professional	TC	$36.31	$51.29	$60.26
Providence Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $58.88 / $112.20	Facility		$38.90	$58.88	$112.20
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 $7.08 / $33.11 / $47.86	Facility	TC	$7.08	$33.11	$47.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $87.10 / $120.23	Professional		$64.57	$87.10	$120.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $22.91 / $31.62	Professional	26	$14.45	$22.91	$31.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $91.20	Professional	TC	$37.15	$61.66	$91.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $371.54 / $467.74	Facility		$295.12	$371.54	$467.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	TC	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $85.11 / $109.65	Professional		$67.61	$85.11	$109.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $22.91 / $29.51	Professional	26	$19.50	$22.91	$29.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $61.66 / $81.28	Professional	TC	$47.86	$61.66	$81.28
United Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $389.05 / $512.86	Facility		$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $48.98 / $107.15	Professional		$39.81	$48.98	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.45 / $30.20	Professional	26	$11.48	$14.45	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $79.43	Professional	TC	$28.18	$34.67	$79.43