Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.57 / $101.14 / $154.32	Facility		$83.57	$101.14	$154.32
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.59 / $68.56 / $313.86	Facility	26	$51.59	$68.56	$313.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.14 / $90.20 / $178.02	Professional		$52.14	$90.20	$178.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.31 / $48.42 / $133.63	Professional	26	$29.31	$48.42	$133.63
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $165.74 / $179.00	Professional	50	$82.23	$165.74	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $36.89 / $64.75	Professional	TC	$16.98	$36.89	$64.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.29 / $301.52 / $367.38	Facility		$19.29	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.01 / $127.32 / $191.96	Professional		$83.01	$127.32	$191.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.42 / $73.91 / $112.28	Professional	26	$48.42	$73.91	$112.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.38 / $49.61 / $83.70	Professional	TC	$31.38	$49.61	$83.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.71 / $106.88 / $127.53	Professional		$91.71	$106.88	$127.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.70 / $67.56 / $78.80	Professional	26	$57.70	$67.56	$78.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.74 / $39.47 / $48.76	Professional	TC	$33.74	$39.47	$48.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $48.28 / $100.52 / $224.93	Facility		$48.28	$100.52	$224.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.33 / $111.50 / $151.96	Professional		$76.33	$111.50	$151.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $63.14 / $95.48	Professional	26	$48.03	$63.14	$95.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.28 / $37.47 / $56.22	Professional	TC	$28.28	$37.47	$56.22
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $78.63 / $96.48 / $177.55	Facility		$78.63	$96.48	$177.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $49.49 / $59.75 / $100.50	Facility	26	$49.49	$59.75	$100.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.86 / $76.50 / $103.49	Professional	26	$51.86	$76.50	$103.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.76 / $57.66 / $79.52	Professional	TC	$30.76	$57.66	$79.52
Providence Facility/Professional Facility Modifier Low / Median / High Price $61.48 / $122.71 / $224.93	Facility		$61.48	$122.71	$224.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $86.71 / $119.52 / $174.90	Professional		$86.71	$119.52	$174.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.32 / $73.91 / $117.73	Professional	26	$47.32	$73.91	$117.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.38 / $49.60 / $86.04	Professional	TC	$31.38	$49.60	$86.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $456.32	Facility		$312.19	$372.00	$456.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.59 / $118.15 / $161.36	Professional		$87.59	$118.15	$161.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $56.29 / $73.84 / $96.38	Professional	26	$56.29	$73.84	$96.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.39 / $44.31 / $64.65	Professional	TC	$33.39	$44.31	$64.65
United Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $94.15 / $158.72	Professional		$53.77	$94.15	$158.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $53.90 / $99.59	Professional	26	$32.11	$53.90	$99.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.65 / $40.25 / $62.01	Professional	TC	$21.65	$40.25	$62.01