Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.54 / $92.79 / $304.27	Facility		$62.54	$92.79	$304.27
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.08 / $33.08 / $51.23	Facility	26	$33.08	$33.08	$51.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.45 / $134.56 / $278.01	Facility	TC	$29.45	$134.56	$278.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.10 / $70.14 / $132.78	Professional		$35.10	$70.14	$132.78
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.18 / $26.23 / $64.73	Professional	26	$18.18	$26.23	$64.73
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.49 / $25.43 / $49.38	Professional	52	$13.49	$25.43	$49.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.49 / $49.70 / $90.86	Professional	TC	$12.49	$49.70	$90.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.36 / $95.66 / $135.91	Professional		$58.36	$95.66	$135.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.77 / $40.79 / $59.99	Professional	26	$24.77	$40.79	$59.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.15 / $49.17 / $80.97	Professional	TC	$28.15	$49.17	$80.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.47 / $85.59 / $98.16	Professional		$72.47	$85.59	$98.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.25 / $47.05 / $53.12	Professional	26	$39.25	$47.05	$53.12
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.15 / $38.38 / $45.05	Professional	TC	$32.15	$38.38	$45.05
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.02 / $72.48 / $177.46	Facility		$32.02	$72.48	$177.46
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.71 / $90.53 / $133.59	Professional		$58.71	$90.53	$133.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.54 / $41.58 / $64.70	Professional	26	$32.54	$41.58	$64.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.15 / $37.25 / $52.70	Professional	TC	$26.15	$37.25	$52.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $60.48 / $74.37 / $145.41	Facility		$60.48	$74.37	$145.41
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.32 / $40.44 / $41.57	Facility	26	$33.32	$40.44	$41.57
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $26.94 / $33.50 / $83.08	Facility	TC	$26.94	$33.50	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $38.76 / $46.75	Professional	26	$27.82	$38.76	$46.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $27.50 / $70.20 / $97.68	Professional	TC	$27.50	$70.20	$97.68
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.90 / $82.57 / $166.45	Facility		$32.90	$82.57	$166.45
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Providence Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.93 / $92.41 / $142.08	Professional		$67.93	$92.41	$142.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.63 / $42.98 / $60.24	Professional	26	$27.63	$42.98	$60.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.30 / $46.76 / $89.04	Professional	TC	$27.30	$46.76	$89.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $307.31 / $415.67 / $478.20	Facility		$307.31	$415.67	$478.20
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	TC	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $89.81 / $137.25	Professional		$70.20	$89.81	$137.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.63 / $44.20 / $58.50	Professional	26	$37.63	$44.20	$58.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $30.99 / $41.03 / $95.77	Professional	TC	$30.99	$41.03	$95.77
United Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $87.62 / $146.96	Professional		$45.83	$87.62	$146.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $40.89 / $63.04	Professional	26	$22.01	$40.89	$63.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.76 / $43.56 / $98.34	Professional	TC	$23.76	$43.56	$98.34