Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $55.92 / $244.44 / $425.42	Facility		$55.92	$244.44	$425.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.09 / $16.19 / $40.39	Facility	26	$11.09	$16.19	$40.39
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.12 / $176.16 / $467.30	Facility	TC	$42.12	$176.16	$467.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.19 / $47.79 / $131.96	Professional		$18.19	$47.79	$131.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $14.00 / $44.75	Professional	26	$7.61	$14.00	$44.75
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.24 / $65.48 / $119.52	Professional	50	$30.24	$65.48	$119.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.23 / $18.02 / $46.56	Professional	52	$11.23	$18.02	$46.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.32 / $38.52 / $89.06	Professional	TC	$21.32	$38.52	$89.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.83 / $223.86 / $304.19	Facility		$28.83	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.25 / $9.25 / $9.25	Facility	26	$9.25	$9.25	$9.25
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.21 / $60.47 / $95.04	Professional		$31.21	$60.47	$95.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $15.68 / $23.16	Professional	26	$9.31	$15.68	$23.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.20 / $46.71 / $73.37	Professional	TC	$23.20	$46.71	$73.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.09 / $79.86 / $92.50	Professional		$67.09	$79.86	$92.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $18.29 / $20.59	Professional	26	$15.31	$18.29	$20.59
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.31 / $61.26 / $71.89	Professional	TC	$51.31	$61.26	$71.89
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $30.30 / $62.00 / $102.75	Facility		$30.30	$62.00	$102.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $57.40 / $103.39	Professional		$45.50	$57.40	$103.39
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.80 / $15.84 / $24.39	Professional	26	$12.80	$15.84	$24.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.35 / $50.96 / $80.31	Professional	TC	$38.35	$50.96	$80.31
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $59.40 / $69.01	Facility		$40.00	$59.40	$69.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.63 / $15.72 / $16.07	Facility	26	$11.63	$15.72	$16.07
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $33.06 / $45.56 / $52.93	Facility	TC	$33.06	$45.56	$52.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $13.92 / $17.76	Professional	26	$9.65	$13.92	$17.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.34 / $38.28 / $47.16	Professional	TC	$27.34	$38.28	$47.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.47 / $71.40 / $102.75	Facility		$34.47	$71.40	$102.75
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.25 / $9.25 / $9.25	Facility	26	$9.25	$9.25	$9.25
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $29.46 / $29.46 / $29.46	Facility	TC	$29.46	$29.46	$29.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.65 / $72.09 / $97.85	Professional		$49.65	$72.09	$97.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $10.87 / $16.28 / $23.60	Professional	26	$10.87	$16.28	$23.60
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $37.65 / $39.88 / $39.88	Professional	52	$37.65	$39.88	$39.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.89 / $51.48 / $74.09	Professional	TC	$30.89	$51.48	$74.09
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 $57.95 / $70.56 / $93.95	Professional		$57.95	$70.56	$93.95
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 $43.51 / $54.12 / $72.06	Professional	TC	$43.51	$54.12	$72.06
United Facility/Professional Professional Modifier Low / Median / High Price $29.11 / $35.40 / $94.94	Professional		$29.11	$35.40	$94.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.60 / $9.46 / $24.77	Professional	26	$8.60	$9.46	$24.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.82 / $28.77 / $70.28	Professional	TC	$20.82	$28.77	$70.28