Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $125.89 / $389.05	Facility		$77.62	$125.89	$389.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $64.57 / $316.23	Facility	26	$41.69	$64.57	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $89.13 / $199.53	Professional		$50.12	$89.13	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $48.98 / $181.97	Professional	26	$25.70	$48.98	$181.97
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $74.13 / $151.36 / $316.23	Professional	50	$74.13	$151.36	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $30.90 / $51.29	Professional	TC	$14.13	$30.90	$51.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.50 / $302.00 / $371.54	Facility		$19.50	$302.00	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $109.65 / $190.55	Professional		$67.61	$109.65	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $109.65	Professional	26	$41.69	$66.07	$109.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $44.67 / $85.11	Professional	TC	$25.12	$44.67	$85.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $102.33 / $125.89	Professional		$83.18	$102.33	$125.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $64.57 / $77.62	Professional	26	$50.12	$64.57	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $38.90 / $48.98	Professional	TC	$32.36	$38.90	$48.98
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $89.13 / $199.53	Facility		$46.77	$89.13	$199.53
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $51.29 / $316.23	Facility	26	$41.69	$51.29	$316.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $107.15 / $169.82	Professional		$72.44	$107.15	$169.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $63.10 / $89.13	Professional	26	$45.71	$63.10	$89.13
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $165.96 / $346.74	Professional	50	$83.18	$165.96	$346.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $40.74 / $58.88	Professional	TC	$27.54	$40.74	$58.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $95.50 / $173.78	Facility		$79.43	$95.50	$173.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $60.26 / $100.00	Facility	26	$48.98	$60.26	$100.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $102.33	Professional	26	$51.29	$77.62	$102.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $77.62	Professional	TC	$30.20	$57.54	$77.62
Providence Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $97.72 / $199.53	Facility		$48.98	$97.72	$199.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $114.82 / $181.97	Professional		$85.11	$114.82	$181.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $112.20	Professional	26	$47.86	$75.86	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $50.12 / $85.11	Professional	TC	$30.20	$50.12	$85.11
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $371.54 / $457.09	Facility		$295.12	$371.54	$457.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $114.82 / $169.82	Professional		$87.10	$114.82	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $97.72	Professional	26	$54.95	$70.79	$97.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $42.66 / $66.07	Professional	TC	$33.11	$42.66	$66.07
United Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $389.05 / $512.86	Facility		$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $93.33 / $158.49	Professional		$53.70	$93.33	$158.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $53.70 / $93.33	Professional	26	$32.36	$53.70	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $64.57	Professional	TC	$21.38	$39.81	$64.57