Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $154.88 / $165.96	Facility		$87.10	$154.88	$165.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $81.28 / $91.20	Facility	26	$47.86	$81.28	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $100.00 / $363.08	Professional		$40.74	$100.00	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $54.95 / $138.04	Professional	26	$33.11	$54.95	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $162.18	Professional	TC	$25.70	$43.65	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $147.91 / $398.11	Professional		$72.44	$147.91	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $75.86 / $162.18	Professional	26	$41.69	$75.86	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $66.07 / $257.04	Professional	TC	$31.62	$66.07	$257.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $144.54 / $169.82	Professional		$117.49	$144.54	$169.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $79.43 / $93.33	Professional	26	$66.07	$79.43	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $66.07 / $77.62	Professional	TC	$52.48	$66.07	$77.62
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $138.04 / $407.38	Facility		$66.07	$138.04	$407.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $144.54 / $363.08	Professional		$79.43	$144.54	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $81.28 / $141.25	Professional	26	$42.66	$81.28	$141.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $64.57 / $218.78	Professional	TC	$33.11	$64.57	$218.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $125.89 / $354.81	Facility		$104.71	$125.89	$354.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $70.79 / $141.25	Facility	26	$60.26	$70.79	$141.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $43.65 / $43.65	Professional		$43.65	$43.65	$43.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $79.43 / $144.54	Professional	26	$50.12	$79.43	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $218.78	Professional	TC	$41.69	$61.66	$218.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $131.83 / $407.38	Facility		$66.07	$131.83	$407.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $63.10	Facility	26	$9.33	$43.65	$63.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $147.91 / $371.54	Professional		$97.72	$147.91	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $158.49	Professional	26	$51.29	$91.20	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $72.44 / $239.88	Professional	TC	$40.74	$72.44	$239.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $501.19 / $630.96	Facility		$389.05	$501.19	$630.96
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $346.74	Professional		$114.82	$131.83	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $138.04	Professional	26	$64.57	$75.86	$138.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $56.23 / $204.17	Professional	TC	$48.98	$56.23	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $1,071.52 / $6,165.95	Facility		$389.05	$1,071.52	$6,165.95
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $338.84	Professional		$89.13	$154.88	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $141.25	Professional	26	$50.12	$83.18	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $67.61 / $204.17	Professional	TC	$38.02	$67.61	$204.17