Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.67 / $246.40 / $443.65	Facility		$56.67	$246.40	$443.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.58 / $18.12 / $42.22	Facility	26	$11.58	$18.12	$42.22
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $43.50 / $227.48 / $432.40	Facility	TC	$43.50	$227.48	$432.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.36 / $44.75 / $132.00	Professional		$12.36	$44.75	$132.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $13.86 / $42.59	Professional	26	$7.78	$13.86	$42.59
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.82 / $85.04 / $112.99	Professional	50	$39.82	$85.04	$112.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.00 / $19.29 / $49.79	Professional	52	$12.00	$19.29	$49.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.95 / $40.24 / $116.00	Professional	TC	$21.95	$40.24	$116.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.40 / $223.86 / $304.19	Facility		$31.40	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $31.68 / $31.68 / $31.68	Facility	TC	$31.68	$31.68	$31.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.99 / $64.87 / $101.63	Professional		$33.99	$64.87	$101.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $16.37 / $24.12	Professional	26	$9.31	$16.37	$24.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.18 / $50.16 / $78.94	Professional	TC	$25.18	$50.16	$78.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $71.70 / $85.38 / $99.00	Professional		$71.70	$85.38	$99.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $19.12 / $21.52	Professional	26	$15.96	$19.12	$21.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.26 / $65.98 / $77.47	Professional	TC	$55.26	$65.98	$77.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $63.44 / $110.06	Facility		$32.36	$63.44	$110.06
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.22 / $61.71 / $112.83	Professional		$50.22	$61.71	$112.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $16.18 / $25.41	Professional	26	$13.35	$16.18	$25.41
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $35.31 / $35.31 / $35.31	Professional	50	$35.31	$35.31	$35.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.94 / $54.88 / $87.42	Professional	TC	$38.94	$54.88	$87.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $43.12 / $62.98 / $73.70	Facility		$43.12	$62.98	$73.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.25 / $16.75	Facility	26	$12.25	$16.25	$16.75
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $33.74 / $48.91 / $56.95	Facility	TC	$33.74	$48.91	$56.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.05 / $14.02 / $17.63	Professional	26	$10.05	$14.02	$17.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $29.35 / $39.04 / $51.13	Professional	TC	$29.35	$39.04	$51.13
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.75 / $76.50 / $110.06	Facility		$36.75	$76.50	$110.06
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $9.61	Facility	26	$9.61	$9.61	$9.61
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $31.68 / $31.68 / $31.68	Facility	TC	$31.68	$31.68	$31.68
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.07 / $77.00 / $104.50	Professional		$53.07	$77.00	$104.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.25 / $16.77 / $24.58	Professional	26	$11.25	$16.77	$24.58
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $40.29 / $42.59 / $42.59	Professional	52	$40.29	$42.59	$42.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.52 / $55.46 / $79.73	Professional	TC	$33.52	$55.46	$79.73
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 $61.44 / $75.34 / $100.99	Professional		$61.44	$75.34	$100.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.96 / $17.77 / $23.69	Professional	26	$14.96	$17.77	$23.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $46.13 / $58.23 / $78.23	Professional	TC	$46.13	$58.23	$78.23
United Facility/Professional Facility Modifier Low / Median / High Price $47.66 / $47.66 / $47.66	Facility		$47.66	$47.66	$47.66
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $43.94 / $101.30	Professional		$31.62	$43.94	$101.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $10.56 / $25.79	Professional	26	$8.94	$10.56	$25.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.28 / $28.47 / $75.34	Professional	TC	$22.28	$28.47	$75.34