Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $269.15 / $407.38	Facility		$63.10	$269.15	$407.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $19.05 / $40.74	Facility	26	$11.48	$19.05	$40.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.81 / $199.53 / $436.52	Facility	TC	$39.81	$199.53	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $45.71 / $131.83	Professional		$12.02	$45.71	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.80 / $43.65	Professional	26	$7.94	$13.80	$43.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.67 / $91.20 / $218.78	Professional	50	$34.67	$91.20	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $45.71 / $85.11	Professional	TC	$21.88	$45.71	$85.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $239.88 / $302.00	Facility		$31.62	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $67.61 / $104.71	Professional		$30.90	$67.61	$104.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.85 / $24.55	Professional	26	$8.91	$15.85	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $51.29 / $81.28	Professional	TC	$23.44	$51.29	$81.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $79.43 / $100.00	Professional		$70.79	$79.43	$100.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $17.78 / $21.38	Professional	26	$15.85	$17.78	$21.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $61.66 / $77.62	Professional	TC	$54.95	$61.66	$77.62
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $72.44 / $346.74	Facility		$35.48	$72.44	$346.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $16.98 / $44.67	Facility	26	$11.48	$16.98	$44.67
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $39.81 / $199.53 / $537.03	Facility	TC	$39.81	$199.53	$537.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $12.30 / $57.54 / $109.65	Professional		$12.30	$57.54	$109.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.85 / $27.54	Professional	26	$8.71	$15.85	$27.54
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $102.33 / $288.40	Professional	50	$39.81	$102.33	$288.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $53.70 / $83.18	Professional	TC	$28.18	$53.70	$83.18
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $66.07 / $74.13	Facility		$46.77	$66.07	$74.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $16.60 / $16.60	Facility	26	$13.80	$16.60	$16.60
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $48.98 / $57.54	Facility	TC	$34.67	$48.98	$57.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $18.62	Professional	26	$10.00	$15.14	$18.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $40.74 / $52.48	Professional	TC	$29.51	$40.74	$52.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $53.70 / $93.33	Facility		$33.11	$53.70	$93.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	TC	$6.46	$30.20	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $72.44 / $107.15	Professional		$54.95	$72.44	$107.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.38 / $24.55	Professional	26	$11.48	$17.38	$24.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $52.48 / $81.28	Professional	TC	$33.11	$52.48	$81.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $281.84 / $354.81	Facility		$204.17	$281.84	$354.81
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	TC	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $74.13 / $97.72	Professional		$60.26	$74.13	$97.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $17.78 / $22.91	Professional	26	$15.14	$17.78	$22.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $56.23 / $75.86	Professional	TC	$42.66	$56.23	$75.86
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $323.59 / $426.58	Facility		$263.03	$323.59	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $38.90 / $95.50	Professional		$30.90	$38.90	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.47 / $23.44	Professional	26	$8.32	$10.47	$23.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $28.84 / $74.13	Professional	TC	$22.39	$28.84	$74.13