Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.55 / $219.08 / $524.58	Facility		$62.55	$219.08	$524.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.53 / $19.59 / $45.74	Facility	26	$12.53	$19.59	$45.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $52.77 / $188.18 / $393.06	Facility	TC	$52.77	$188.18	$393.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.00 / $54.06 / $158.00	Professional		$20.00	$54.06	$158.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.86 / $14.07 / $49.64	Professional	26	$8.86	$14.07	$49.64
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.27 / $34.00 / $249.00	Professional	50	$19.27	$34.00	$249.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.32 / $21.40 / $55.76	Professional	52	$13.32	$21.40	$55.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $43.98 / $130.00	Professional	TC	$24.44	$43.98	$130.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $34.71 / $223.86 / $304.19	Facility		$34.71	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.08 / $71.37 / $113.30	Professional		$37.08	$71.37	$113.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $17.95 / $26.24	Professional	26	$10.47	$17.95	$26.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.75 / $56.22 / $89.19	Professional	TC	$28.75	$56.22	$89.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.31 / $95.65 / $110.94	Professional		$80.31	$95.65	$110.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $20.68 / $23.29	Professional	26	$17.23	$20.68	$23.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $62.53 / $74.67 / $87.65	Professional	TC	$62.53	$74.67	$87.65
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.90 / $71.38 / $121.52	Facility		$35.90	$71.38	$121.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.00 / $69.06 / $124.02	Professional		$57.00	$69.06	$124.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $17.46 / $27.45	Professional	26	$14.40	$17.46	$27.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.58 / $59.00 / $96.57	Professional	TC	$41.58	$59.00	$96.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $49.00 / $71.15 / $82.41	Facility		$49.00	$71.15	$82.41
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.23 / $17.78 / $18.36	Facility	26	$13.23	$17.78	$18.36
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $36.75 / $54.87 / $64.31	Facility	TC	$36.75	$54.87	$64.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.85 / $15.38 / $20.25	Professional	26	$10.85	$15.38	$20.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.36 / $42.43 / $59.50	Professional	TC	$33.36	$42.43	$59.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $40.36 / $87.55 / $122.63	Facility		$40.36	$87.55	$122.63
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $86.10 / $115.90	Professional		$59.52	$86.10	$115.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $18.37 / $26.55	Professional	26	$12.23	$18.37	$26.55
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $47.24 / $47.24 / $47.24	Professional	52	$47.24	$47.24	$47.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.84 / $62.13 / $90.10	Professional	TC	$37.84	$62.13	$90.10
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 $68.48 / $84.26 / $111.28	Professional		$68.48	$84.26	$111.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $19.19 / $25.58	Professional	26	$16.16	$19.19	$25.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.04 / $65.76 / $86.65	Professional	TC	$51.04	$65.76	$86.65
United Facility/Professional Professional Modifier Low / Median / High Price $34.50 / $51.61 / $113.70	Professional		$34.50	$51.61	$113.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $11.04 / $27.64	Professional	26	$9.38	$11.04	$27.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $32.19 / $85.80	Professional	TC	$24.44	$32.19	$85.80