Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $338.84 / $380.19	Facility		$245.47	$338.84	$380.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $181.97 / $204.17	Facility	26	$128.82	$181.97	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $194.98 / $371.54	Professional		$117.49	$194.98	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $81.28 / $204.17	Professional	26	$50.12	$81.28	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	52	$134.90	$134.90	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $107.15 / $208.93	Professional	TC	$57.54	$107.15	$208.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $8,511.38 / $10,964.78	Facility		$75.86	$8,511.38	$10,964.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $323.59 / $549.54	Professional		$204.17	$323.59	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $134.90 / $239.88	Professional	26	$61.66	$134.90	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $177.83 / $426.58	Professional	TC	$100.00	$177.83	$426.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $389.05	Professional		$281.84	$323.59	$389.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $169.82 / $204.17	Professional	26	$147.91	$169.82	$204.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $147.91 / $186.21	Professional	TC	$131.83	$147.91	$186.21
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $281.84 / $660.69	Facility		$147.91	$281.84	$660.69
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $204.17 / $204.17	Facility	26	$204.17	$204.17	$204.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $309.03 / $562.34	Professional		$181.97	$309.03	$562.34
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $154.88 / $239.88	Professional	26	$74.13	$154.88	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $158.49 / $562.34	Professional	TC	$107.15	$158.49	$562.34
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $295.12 / $524.81	Facility		$245.47	$295.12	$524.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $138.04 / $165.96	Facility	26	$91.20	$138.04	$165.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $102.33 / $154.88	Professional	26	$74.13	$102.33	$154.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $165.96 / $302.00	Professional	TC	$97.72	$165.96	$302.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $288.40 / $758.58	Facility		$151.36	$288.40	$758.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $338.84 / $467.74	Professional		$257.04	$338.84	$467.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $234.42	Professional	26	$89.13	$138.04	$234.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $190.55 / $363.08	Professional	TC	$112.20	$190.55	$363.08
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $7,762.47 / $9,549.93 / $12,302.69	Facility		$7,762.47	$9,549.93	$12,302.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $8,317.64 / $8,317.64 / $8,317.64	Facility	26	$8,317.64	$8,317.64	$8,317.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $331.13 / $416.87	Professional		$269.15	$331.13	$416.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $169.82 / $218.78	Professional	26	$107.15	$169.82	$218.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $165.96 / $218.78	Professional	TC	$125.89	$165.96	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $9,549.93 / $11,748.98 / $15,488.17	Facility		$9,549.93	$11,748.98	$15,488.17
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $288.40 / $489.78	Professional		$165.96	$288.40	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $218.78	Professional	26	$56.23	$91.20	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $138.04 / $316.23	Professional	TC	$79.43	$138.04	$316.23