Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.91 / $146.81 / $353.70	Facility		$52.91	$146.81	$353.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $18.05 / $49.17	Facility	26	$11.16	$18.05	$49.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.71 / $73.37 / $313.50	Facility	TC	$36.71	$73.37	$313.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $40.47 / $110.20	Professional		$12.01	$40.47	$110.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.22 / $11.42 / $43.00	Professional	26	$7.22	$11.42	$43.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.65 / $120.00 / $208.50	Professional	50	$33.65	$120.00	$208.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.12 / $18.02 / $46.59	Professional	52	$11.12	$18.02	$46.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $32.15 / $105.00	Professional	TC	$19.46	$32.15	$105.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.83 / $223.86 / $304.19	Facility		$28.83	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.66 / $61.37 / $94.73	Professional		$31.66	$61.37	$94.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.72 / $15.93 / $23.33	Professional	26	$9.72	$15.93	$23.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.89 / $46.71 / $73.17	Professional	TC	$22.89	$46.71	$73.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.06 / $79.88 / $92.58	Professional		$67.06	$79.88	$92.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $18.36 / $20.67	Professional	26	$15.31	$18.36	$20.67
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.31 / $61.26 / $71.89	Professional	TC	$51.31	$61.26	$71.89
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $29.93 / $57.24 / $87.01	Facility		$29.93	$57.24	$87.01
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $57.73 / $102.37	Professional		$45.00	$57.73	$102.37
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $16.37 / $25.45	Professional	26	$12.80	$16.37	$25.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.64 / $50.96 / $80.31	Professional	TC	$35.64	$50.96	$80.31
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $42.15 / $58.96 / $69.01	Facility		$42.15	$58.96	$69.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.78 / $16.32	Facility	26	$11.76	$15.78	$16.32
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $30.87 / $44.88 / $52.93	Facility	TC	$30.87	$44.88	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.75 / $14.66 / $18.00	Professional	26	$9.75	$14.66	$18.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.89 / $35.99 / $51.30	Professional	TC	$27.89	$35.99	$51.30
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.10 / $74.70 / $102.79	Facility		$34.10	$74.70	$102.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.19 / $9.19 / $9.19	Facility	26	$9.19	$9.19	$9.19
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.33 / $72.09 / $97.85	Professional		$51.33	$72.09	$97.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.87 / $16.72 / $23.60	Professional	26	$10.87	$16.72	$23.60
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $37.65 / $39.50 / $39.50	Professional	52	$37.65	$39.50	$39.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.11 / $51.48 / $74.09	Professional	TC	$30.11	$51.48	$74.09
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 $57.34 / $71.47 / $93.71	Professional		$57.34	$71.47	$93.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $17.28 / $22.74	Professional	26	$14.36	$17.28	$22.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.59 / $54.12 / $71.87	Professional	TC	$40.59	$54.12	$71.87
United Facility/Professional Professional Modifier Low / Median / High Price $29.47 / $34.67 / $97.14	Professional		$29.47	$34.67	$97.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $11.26 / $25.52	Professional	26	$8.61	$11.26	$25.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $27.30 / $72.23	Professional	TC	$20.21	$27.30	$72.23