Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.23 / $137.08 / $315.76	Facility		$49.23	$137.08	$315.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.09 / $18.07 / $36.10	Facility	26	$12.09	$18.07	$36.10
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.14 / $177.60 / $297.14	Facility	TC	$33.14	$177.60	$297.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.69 / $41.45 / $112.60	Professional		$24.69	$41.45	$112.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $12.05 / $38.18	Professional	26	$8.22	$12.05	$38.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $25.97 / $59.67	Professional	TC	$16.60	$25.97	$59.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.33 / $223.86 / $304.19	Facility		$23.33	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.91 / $54.59 / $83.58	Professional		$29.91	$54.59	$83.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.07 / $17.03 / $25.11	Professional	26	$10.07	$17.03	$25.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.04 / $37.79 / $59.97	Professional	TC	$20.04	$37.79	$59.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $59.16 / $70.34 / $81.31	Professional		$59.16	$70.34	$81.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $19.88 / $22.38	Professional	26	$16.60	$19.88	$22.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $42.05 / $50.21 / $58.94	Professional	TC	$42.05	$50.21	$58.94
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $24.41 / $49.41 / $89.12	Facility		$24.41	$49.41	$89.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.80 / $55.89 / $91.50	Professional		$44.80	$55.89	$91.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.88 / $18.45 / $26.43	Professional	26	$13.88	$18.45	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.15 / $45.41 / $65.06	Professional	TC	$34.15	$45.41	$65.06
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $36.94 / $55.26 / $60.97	Facility		$36.94	$55.26	$60.97
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.43 / $17.12 / $17.42	Facility	26	$11.43	$17.12	$17.42
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $35.19 / $41.48 / $43.55	Facility	TC	$35.19	$41.48	$43.55
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $10.45 / $14.29 / $17.42	Professional	26	$10.45	$14.29	$17.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $42.05 / $43.55	Professional	TC	$28.14	$42.05	$43.55
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.36 / $72.27 / $94.50	Facility		$29.36	$72.27	$94.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.01 / $10.01 / $10.01	Facility	26	$10.01	$10.01	$10.01
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.43 / $64.80 / $86.45	Professional		$45.43	$64.80	$86.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $17.71 / $25.57	Professional	26	$11.69	$17.71	$25.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.69 / $41.53 / $60.89	Professional	TC	$26.69	$41.53	$60.89
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 $53.87 / $65.09 / $85.28	Professional		$53.87	$65.09	$85.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.56 / $19.25 / $24.64	Professional	26	$15.56	$19.25	$24.64
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $38.21 / $45.60 / $60.64	Professional	TC	$38.21	$45.60	$60.64
United Facility/Professional Professional Modifier Low / Median / High Price $27.63 / $35.29 / $84.61	Professional		$27.63	$35.29	$84.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $11.62 / $26.93	Professional	26	$9.31	$11.62	$26.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $25.97 / $60.39	Professional	TC	$18.32	$25.97	$60.39