Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.22 / $144.59 / $343.39	Facility		$49.22	$144.59	$343.39
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.05 / $18.77 / $40.61	Facility	26	$12.05	$18.77	$40.61
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.68 / $61.78 / $316.77	Facility	TC	$38.68	$61.78	$316.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.63 / $41.80 / $141.60	Professional		$19.63	$41.80	$141.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.42 / $12.36 / $50.42	Professional	26	$8.42	$12.36	$50.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $29.29 / $67.50	Professional	TC	$20.96	$29.29	$67.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.57 / $223.86 / $304.19	Facility		$29.57	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	TC	$30.20	$30.20	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.07 / $64.84 / $98.77	Professional		$35.07	$64.84	$98.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.43 / $17.51 / $25.57	Professional	26	$10.43	$17.51	$25.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.96 / $47.90 / $76.00	Professional	TC	$24.96	$47.90	$76.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.40 / $83.78 / $97.05	Professional		$70.40	$83.78	$97.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $19.88 / $22.38	Professional	26	$16.60	$19.88	$22.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $53.27 / $63.61 / $74.69	Professional	TC	$53.27	$63.61	$74.69
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $28.82 / $57.94 / $89.84	Facility		$28.82	$57.94	$89.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $54.32 / $62.30 / $108.78	Professional		$54.32	$62.30	$108.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $18.45 / $26.43	Professional	26	$13.88	$18.45	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.23 / $57.12 / $82.35	Professional	TC	$43.23	$57.12	$82.35
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $44.57 / $64.98 / $71.69	Facility		$44.57	$64.98	$71.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.08 / $17.12 / $18.09	Facility	26	$13.08	$17.12	$18.09
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $32.42 / $47.85 / $54.27	Facility	TC	$32.42	$47.85	$54.27
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $14.30 / $19.19	Professional	26	$10.45	$14.30	$19.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.95 / $44.55 / $54.27	Professional	TC	$30.95	$44.55	$54.27
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.40 / $81.31 / $112.35	Facility		$34.40	$81.31	$112.35
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	TC	$30.20	$30.20	$30.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.69 / $76.13 / $101.65	Professional		$53.69	$76.13	$101.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.78 / $18.10 / $25.57	Professional	26	$11.78	$18.10	$25.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.57 / $52.52 / $76.00	Professional	TC	$34.57	$52.52	$76.00
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 $55.97 / $74.37 / $97.35	Professional		$55.97	$74.37	$97.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.56 / $18.53 / $24.64	Professional	26	$15.56	$18.53	$24.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $39.36 / $55.49 / $73.69	Professional	TC	$39.36	$55.49	$73.69
United Facility/Professional Professional Modifier Low / Median / High Price $32.70 / $42.74 / $100.26	Professional		$32.70	$42.74	$100.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $10.64 / $26.82	Professional	26	$9.38	$10.64	$26.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.00 / $30.04 / $73.29	Professional	TC	$23.00	$30.04	$73.29