Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $329.49 / $365.67 / $371.43	Facility		$329.49	$365.67	$371.43
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.51 / $202.32 / $399.96	Facility	26	$173.51	$202.32	$399.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.02 / $216.63 / $405.87	Professional		$97.02	$216.63	$405.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.67 / $72.58 / $203.17	Professional	26	$50.67	$72.58	$203.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $51.92 / $108.32 / $196.80	Professional	52	$51.92	$108.32	$196.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.97 / $162.66 / $235.87	Professional	TC	$51.97	$162.66	$235.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.65 / $7,918.45 / $10,873.93	Facility		$75.65	$7,918.45	$10,873.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.70 / $321.95 / $491.04	Professional		$218.70	$321.95	$491.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.28 / $152.15 / $232.69	Professional	26	$72.28	$152.15	$232.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.84 / $170.89 / $268.95	Professional	TC	$108.84	$170.89	$268.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $287.68 / $342.33 / $389.67	Professional		$287.68	$342.33	$389.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $151.78 / $180.53 / $203.26	Professional	26	$151.78	$180.53	$203.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $132.97 / $158.78 / $186.41	Professional	TC	$132.97	$158.78	$186.41
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $132.75 / $287.69 / $558.69	Facility		$132.75	$287.69	$558.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $244.15 / $301.94 / $471.07	Professional		$244.15	$301.94	$471.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.92 / $164.31 / $247.05	Professional	26	$106.92	$164.31	$247.05
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.81 / $153.55 / $566.79	Professional	TC	$107.81	$153.55	$566.79
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $226.87 / $301.50 / $524.66	Facility		$226.87	$301.50	$524.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $139.08 / $164.15	Facility	26	$91.20	$139.08	$164.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.31 / $103.68 / $155.94	Professional	26	$64.31	$103.68	$155.94
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $112.24 / $185.35 / $320.08	Professional	TC	$112.24	$185.35	$320.08
Providence Facility/Professional Facility Modifier Low / Median / High Price $167.76 / $385.01 / $564.64	Facility		$167.76	$385.01	$564.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.06 / $94.06 / $94.06	Facility	26	$94.06	$94.06	$94.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $261.44 / $352.56 / $450.87	Professional		$261.44	$352.56	$450.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.75 / $155.36 / $238.14	Professional	26	$91.75	$155.36	$238.14
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $175.02 / $175.02 / $175.02	Professional	52	$175.02	$175.02	$175.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.77 / $168.97 / $247.95	Professional	TC	$101.77	$168.97	$247.95
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $7,811.13 / $9,645.90 / $11,923.00	Facility		$7,811.13	$9,645.90	$11,923.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $8,401.03 / $8,401.03 / $8,401.03	Facility	26	$8,401.03	$8,401.03	$8,401.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $269.33 / $339.65 / $426.38	Professional		$269.33	$339.65	$426.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $106.37 / $173.34 / $230.24	Professional	26	$106.37	$173.34	$230.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $123.89 / $166.96 / $231.19	Professional	TC	$123.89	$166.96	$231.19
United Facility/Professional Professional Modifier Low / Median / High Price $162.78 / $277.14 / $499.49	Professional		$162.78	$277.14	$499.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.34 / $97.07 / $250.88	Professional	26	$55.34	$97.07	$250.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $133.58 / $229.75	Professional	TC	$78.67	$133.58	$229.75