Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.64 / $114.37 / $316.80	Facility		$48.64	$114.37	$316.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.15 / $15.95 / $33.25	Facility	26	$10.15	$15.95	$33.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.09 / $47.61 / $276.45	Facility	TC	$30.09	$47.61	$276.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $39.54 / $135.49	Professional		$24.62	$39.54	$135.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $10.65 / $41.00	Professional	26	$6.71	$10.65	$41.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $20.64 / $76.58 / $76.58	Professional	50	$20.64	$76.58	$76.58
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.14 / $16.10 / $79.83	Professional	52	$9.14	$16.10	$79.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.70 / $22.31 / $54.59	Professional	TC	$16.70	$22.31	$54.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $22.96 / $223.86 / $304.19	Facility		$22.96	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.29 / $51.73 / $79.09	Professional		$28.29	$51.73	$79.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $14.34 / $21.22	Professional	26	$8.55	$14.34	$21.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.44 / $37.82 / $59.03	Professional	TC	$20.44	$37.82	$59.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $55.84 / $66.44 / $76.81	Professional		$55.84	$66.44	$76.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.03 / $16.72 / $18.82	Professional	26	$14.03	$16.72	$18.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.38 / $49.41 / $58.00	Professional	TC	$41.38	$49.41	$58.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $24.70 / $50.37 / $75.00	Facility		$24.70	$50.37	$75.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $42.56 / $48.99 / $84.48	Professional		$42.56	$48.99	$84.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.87 / $22.38	Professional	26	$11.75	$14.87	$22.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.63 / $44.43 / $64.05	Professional	TC	$33.63	$44.43	$64.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $35.36 / $50.40 / $57.62	Facility		$35.36	$50.40	$57.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.66 / $14.45 / $14.74	Facility	26	$10.66	$14.45	$14.74
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $27.03 / $37.52 / $42.88	Facility	TC	$27.03	$37.52	$42.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $13.20 / $15.18	Professional	26	$8.84	$13.20	$15.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.51 / $32.64 / $39.00	Professional	TC	$22.51	$32.64	$39.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.59 / $62.37 / $85.74	Facility		$29.59	$62.37	$85.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $8.51 / $8.51	Facility	26	$8.51	$8.51	$8.51
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $23.86 / $23.86 / $23.86	Facility	TC	$23.86	$23.86	$23.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $43.07 / $60.43 / $81.48	Professional		$43.07	$60.43	$81.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.97 / $14.90 / $21.63	Professional	26	$9.97	$14.90	$21.63
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $31.25 / $32.53 / $32.53	Professional	52	$31.25	$32.53	$32.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.70 / $41.53 / $59.95	Professional	TC	$27.70	$41.53	$59.95
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 $50.02 / $59.69 / $77.77	Professional		$50.02	$59.69	$77.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.17 / $15.57 / $20.85	Professional	26	$13.17	$15.57	$20.85
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.60 / $43.84 / $57.32	Professional	TC	$36.60	$43.84	$57.32
United Facility/Professional Professional Modifier Low / Median / High Price $26.02 / $33.49 / $80.62	Professional		$26.02	$33.49	$80.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $8.78 / $22.71	Professional	26	$7.88	$8.78	$22.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.30 / $23.65 / $57.88	Professional	TC	$18.30	$23.65	$57.88