Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $50.23 / $151.96 / $363.20	Facility		$50.23	$151.96	$363.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.11 / $17.37 / $38.76	Facility	26	$11.11	$17.37	$38.76
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $57.06 / $332.50	Facility	TC	$34.67	$57.06	$332.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.87 / $37.68 / $142.10	Professional		$17.87	$37.68	$142.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.13 / $40.45	Professional	26	$7.03	$11.13	$40.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.70 / $88.20 / $111.19	Professional	50	$48.70	$88.20	$111.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.46 / $17.14 / $43.83	Professional	52	$10.46	$17.14	$43.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $24.36 / $56.85	Professional	TC	$18.53	$24.36	$56.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $27.00 / $223.86 / $304.19	Facility		$27.00	$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 $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.29 / $57.52 / $89.17	Professional		$29.29	$57.52	$89.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $15.71 / $23.13	Professional	26	$8.61	$15.71	$23.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.80 / $43.74 / $68.45	Professional	TC	$21.80	$43.74	$68.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.11 / $75.14 / $87.03	Professional		$63.11	$75.14	$87.03
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 $47.99 / $57.30 / $67.27	Professional	TC	$47.99	$57.30	$67.27
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $27.80 / $54.26 / $80.53	Facility		$27.80	$54.26	$80.53
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.26 / $54.34 / $99.63	Professional		$45.26	$54.34	$99.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $15.96 / $24.39	Professional	26	$12.28	$15.96	$24.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.32 / $47.85 / $75.23	Professional	TC	$34.32	$47.85	$75.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.70 / $56.28 / $64.98	Facility		$40.70	$56.28	$64.98
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 $29.40 / $42.81 / $49.58	Facility	TC	$29.40	$42.81	$49.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $13.68 / $17.04	Professional	26	$9.65	$13.68	$17.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.73 / $34.20 / $48.00	Professional	TC	$25.73	$34.20	$48.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.46 / $71.84 / $97.57	Facility		$32.46	$71.84	$97.57
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 $27.59 / $27.59 / $27.59	Facility	TC	$27.59	$27.59	$27.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.38 / $67.90 / $92.15	Professional		$48.38	$67.90	$92.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $15.93 / $23.14	Professional	26	$10.42	$15.93	$23.14
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $37.17 / $37.17 / $37.17	Professional	52	$37.17	$37.17	$37.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.66 / $48.40 / $69.37	Professional	TC	$28.66	$48.40	$69.37
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 $53.43 / $67.41 / $89.16	Professional		$53.43	$67.41	$89.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $16.98 / $22.74	Professional	26	$14.36	$16.98	$22.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.74 / $50.69 / $67.33	Professional	TC	$38.74	$50.69	$67.33
United Facility/Professional Professional Modifier Low / Median / High Price $27.31 / $34.71 / $91.99	Professional		$27.31	$34.71	$91.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.60 / $9.19 / $24.76	Professional	26	$8.60	$9.19	$24.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.77 / $25.08 / $76.67	Professional	TC	$18.77	$25.08	$76.67