Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.23 / $274.58 / $602.96	Facility		$97.23	$274.58	$602.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.89 / $64.17 / $89.78	Facility	26	$44.89	$64.17	$89.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.01 / $104.65 / $417.00	Professional		$81.01	$104.65	$417.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $55.21 / $157.00	Professional	26	$30.87	$55.21	$157.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $109.56 / $493.03 / $652.00	Professional	50	$109.56	$493.03	$652.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.56 / $62.37 / $260.00	Professional	TC	$50.56	$62.37	$260.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.19 / $223.86 / $304.19	Facility		$58.19	$223.86	$304.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.51 / $178.79 / $250.76	Professional		$97.51	$178.79	$250.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.47 / $67.39 / $94.40	Professional	26	$37.47	$67.39	$94.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $112.20 / $156.36	Professional	TC	$59.92	$112.20	$156.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.29 / $189.13 / $228.39	Professional		$162.29	$189.13	$228.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.01 / $72.13 / $83.31	Professional	26	$61.01	$72.13	$83.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $100.39 / $117.47 / $145.08	Professional	TC	$100.39	$117.47	$145.08
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $80.76 / $141.15 / $263.14	Facility		$80.76	$141.15	$263.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $135.56 / $150.60 / $269.48	Professional		$135.56	$150.60	$269.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.78 / $66.63 / $102.93	Professional	26	$51.78	$66.63	$102.93
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $92.25 / $92.25 / $136.85	Professional	50	$92.25	$92.25	$136.85
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.79 / $104.10 / $166.56	Professional	TC	$83.79	$104.10	$166.56
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $118.69 / $167.29 / $172.72	Facility		$118.69	$167.29	$172.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $47.00 / $63.80 / $64.98	Facility	26	$47.00	$63.80	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.71 / $54.98 / $66.29	Professional	26	$41.71	$54.98	$66.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $72.38 / $98.56 / $109.10	Professional	TC	$72.38	$98.56	$109.10
Providence Facility/Professional Facility Modifier Low / Median / High Price $88.51 / $207.24 / $263.14	Facility		$88.51	$207.24	$263.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $148.68 / $188.70 / $247.35	Professional		$148.68	$188.70	$247.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.22 / $70.70 / $94.40	Professional	26	$43.22	$70.70	$94.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $117.35 / $156.36	Professional	TC	$71.34	$117.35	$156.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $201.89 / $281.32 / $339.90	Facility		$201.89	$281.32	$339.90
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $209.36 / $209.36 / $209.36	Facility	26	$209.36	$209.36	$209.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $153.72 / $203.89 / $242.56	Professional		$153.72	$203.89	$242.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.41 / $77.06 / $91.91	Professional	26	$59.41	$77.06	$91.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.16 / $126.83 / $150.65	Professional	TC	$95.16	$126.83	$150.65
United Facility/Professional Professional Modifier Low / Median / High Price $89.14 / $101.86 / $255.30	Professional		$89.14	$101.86	$255.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $38.61 / $99.24	Professional	26	$34.65	$38.61	$99.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.49 / $60.68 / $167.58	Professional	TC	$54.49	$60.68	$167.58