Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $288.40 / $512.86	Facility		$97.72	$288.40	$512.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $70.79 / $89.13	Facility	26	$44.67	$70.79	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $114.82 / $446.68	Professional		$67.61	$114.82	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $67.61 / $173.78	Professional	26	$30.20	$67.61	$173.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $69.18 / $251.19 / $691.83	Professional	50	$69.18	$251.19	$691.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $281.84	Professional	TC	$42.66	$61.66	$281.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $239.88 / $302.00	Facility		$57.54	$239.88	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $162.18 / $239.88	Professional		$89.13	$162.18	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $60.26 / $93.33	Professional	26	$36.31	$60.26	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $102.33 / $151.36	Professional	TC	$54.95	$102.33	$151.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $218.78	Professional		$141.25	$177.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $66.07 / $77.62	Professional	26	$51.29	$66.07	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $112.20 / $141.25	Professional	TC	$91.20	$112.20	$141.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $151.36 / $398.11	Facility		$74.13	$151.36	$398.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $63.10 / $87.10	Facility	26	$44.67	$63.10	$87.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $169.82 / $269.15	Professional		$89.13	$169.82	$269.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $66.07 / $107.15	Professional	26	$34.67	$66.07	$107.15
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $67.61 / $169.82 / $724.44	Professional	50	$67.61	$169.82	$724.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $107.15 / $154.88	Professional	TC	$58.88	$107.15	$154.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $165.96 / $173.78	Facility		$125.89	$165.96	$173.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $63.10 / $64.57	Facility	26	$52.48	$63.10	$64.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $54.95 / $67.61	Professional	26	$38.90	$54.95	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $93.33 / $107.15	Professional	TC	$69.18	$93.33	$107.15
Providence Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $123.03 / $218.78	Facility		$79.43	$123.03	$218.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $239.88	Professional		$134.90	$173.78	$239.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $66.07 / $93.33	Professional	26	$42.66	$66.07	$93.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $107.15 / $151.36	Professional	TC	$70.79	$107.15	$151.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $281.84 / $363.08	Facility		$204.17	$281.84	$363.08
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $181.97 / $229.09	Professional		$154.88	$181.97	$229.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $89.13	Professional	26	$58.88	$69.18	$89.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $112.20 / $144.54	Professional	TC	$95.50	$112.20	$144.54
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $323.59 / $426.58	Facility		$263.03	$323.59	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $100.00 / $223.87	Professional		$85.11	$100.00	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $37.15 / $87.10	Professional	26	$33.11	$37.15	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $60.26 / $138.04	Professional	TC	$52.48	$60.26	$138.04