Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $501.19 / $691.83	Facility		$134.90	$501.19	$691.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $60.26 / $144.54	Facility	26	$38.90	$60.26	$144.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $102.33 / $316.23 / $660.69	Facility	TC	$102.33	$316.23	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $131.83 / $549.54	Professional		$77.62	$131.83	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $46.77 / $144.54	Professional	26	$25.12	$46.77	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $83.18 / $213.80	Professional	TC	$50.12	$83.18	$213.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $229.09 / $331.13	Facility		$66.07	$229.09	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $173.78 / $251.19	Professional		$93.33	$173.78	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $52.48 / $77.62	Professional	26	$29.51	$52.48	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $117.49 / $173.78	Professional	TC	$64.57	$117.49	$173.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $229.09	Professional		$147.91	$186.21	$229.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $69.18	Professional	26	$44.67	$57.54	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $125.89 / $158.49	Professional	TC	$102.33	$125.89	$158.49
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $177.83 / $616.60	Facility		$85.11	$177.83	$616.60
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $53.70 / $144.54	Facility	26	$38.90	$53.70	$144.54
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $107.15 / $363.08 / $691.83	Facility	TC	$107.15	$363.08	$691.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $263.03	Professional		$107.15	$169.82	$263.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $54.95 / $93.33	Professional	26	$28.18	$54.95	$93.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $120.23 / $173.78	Professional	TC	$70.79	$120.23	$173.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $169.82 / $194.98	Facility		$141.25	$169.82	$194.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $54.95 / $56.23	Facility	26	$44.67	$54.95	$56.23
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $97.72 / $117.49 / $131.83	Facility	TC	$97.72	$117.49	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $48.98 / $61.66	Professional	26	$34.67	$48.98	$61.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $112.20 / $147.91	Professional	TC	$81.28	$112.20	$147.91
Providence Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $134.90 / $229.09	Facility		$85.11	$134.90	$229.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $190.55 / $251.19	Professional		$141.25	$190.55	$251.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $77.62	Professional	26	$37.15	$57.54	$77.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $131.83 / $173.78	Professional	TC	$87.10	$131.83	$173.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $371.54 / $467.74	Facility		$295.12	$371.54	$467.74
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 Facility Modifier TC Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	TC	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $194.98 / $239.88	Professional		$158.49	$194.98	$239.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $60.26 / $75.86	Professional	26	$50.12	$60.26	$75.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $134.90 / $162.18	Professional	TC	$109.65	$134.90	$162.18
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 $93.33 / $104.71 / $239.88	Professional		$93.33	$104.71	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $31.62 / $74.13	Professional	26	$28.18	$31.62	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $72.44 / $162.18	Professional	TC	$63.10	$72.44	$162.18