Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.50 / $173.85 / $336.26	Facility		$47.50	$173.85	$336.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.63 / $15.50 / $26.60	Facility	26	$10.63	$15.50	$26.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.86 / $66.56 / $291.95	Facility	TC	$36.86	$66.56	$291.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.30 / $38.11 / $127.00	Professional		$17.30	$38.11	$127.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $11.20 / $42.45	Professional	26	$7.33	$11.20	$42.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.28 / $112.62 / $259.50	Professional	50	$55.28	$112.62	$259.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $33.29 / $77.03	Professional	TC	$17.57	$33.29	$77.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.26 / $223.86 / $304.19	Facility		$26.26	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.85 / $26.85 / $26.85	Facility	TC	$26.85	$26.85	$26.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.31 / $55.39 / $87.61	Professional		$29.31	$55.39	$87.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $15.67 / $22.62	Professional	26	$9.31	$15.67	$22.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.92 / $42.55 / $67.51	Professional	TC	$20.92	$42.55	$67.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.45 / $74.34 / $86.09	Professional		$62.45	$74.34	$86.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.67 / $17.55 / $19.76	Professional	26	$14.67	$17.55	$19.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $47.33 / $56.51 / $66.33	Professional	TC	$47.33	$56.51	$66.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $28.19 / $54.16 / $75.90	Facility		$28.19	$54.16	$75.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $46.48 / $53.12 / $96.57	Professional		$46.48	$53.12	$96.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $15.96 / $23.37	Professional	26	$12.28	$15.96	$23.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.32 / $49.14 / $73.20	Professional	TC	$34.32	$49.14	$73.20
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $39.20 / $54.27 / $63.65	Facility		$39.20	$54.27	$63.65
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.76 / $15.11 / $16.07	Facility	26	$11.76	$15.11	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $27.93 / $40.47 / $48.24	Facility	TC	$27.93	$40.47	$48.24
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $27.62 / $27.62 / $27.62	Professional		$27.62	$27.62	$27.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $14.75 / $17.52	Professional	26	$10.76	$14.75	$17.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.65 / $34.54 / $42.46	Professional	TC	$25.65	$34.54	$42.46
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.47 / $69.72 / $94.43	Facility		$31.47	$69.72	$94.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.86 / $8.86 / $8.86	Facility	26	$8.86	$8.86	$8.86
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $26.85 / $26.85 / $26.85	Facility	TC	$26.85	$26.85	$26.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $46.61 / $65.79 / $89.30	Professional		$46.61	$65.79	$89.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $15.97 / $22.62	Professional	26	$10.42	$15.97	$22.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.68 / $47.02 / $67.51	Professional	TC	$29.68	$47.02	$67.51
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 $51.11 / $65.19 / $86.43	Professional		$51.11	$65.19	$86.43
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.77 / $16.39 / $21.79	Professional	26	$13.77	$16.39	$21.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.67 / $49.32 / $65.51	Professional	TC	$35.67	$49.32	$65.51
United Facility/Professional Professional Modifier Low / Median / High Price $27.40 / $40.35 / $88.90	Professional		$27.40	$40.35	$88.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.30 / $10.25 / $23.82	Professional	26	$8.30	$10.25	$23.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.34 / $24.57 / $64.52	Professional	TC	$19.34	$24.57	$64.52