Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $148.58 / $148.58 / $168.89	Facility		$148.58	$148.58	$168.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.06 / $41.06 / $45.31	Facility	26	$41.06	$41.06	$45.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.11 / $131.08 / $175.53	Professional		$61.11	$131.08	$175.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.72 / $20.01 / $44.72	Professional	26	$16.72	$20.01	$44.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.56 / $107.53 / $154.11	Professional	TC	$43.56	$107.53	$154.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $75.31 / $75.31	Facility		$75.31	$75.31	$75.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.69 / $153.07 / $209.19	Professional		$99.69	$153.07	$209.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.94 / $36.33 / $52.43	Professional	26	$22.94	$36.33	$52.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.97 / $114.05 / $177.47	Professional	TC	$73.97	$114.05	$177.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $119.11 / $155.30 / $180.08	Professional		$119.11	$155.30	$180.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.94 / $41.65 / $47.02	Professional	26	$31.94	$41.65	$47.02
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $87.19 / $113.32 / $133.03	Professional	TC	$87.19	$113.32	$133.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $67.92 / $120.92 / $323.85	Facility		$67.92	$120.92	$323.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.86 / $139.63 / $260.82	Professional		$76.86	$139.63	$260.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.83 / $33.65 / $57.30	Professional	26	$28.83	$33.65	$57.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.87 / $102.74 / $152.78	Professional	TC	$69.87	$102.74	$152.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $108.88 / $135.34 / $250.58	Facility		$108.88	$135.34	$250.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.68 / $35.36 / $36.18	Facility	26	$25.68	$35.36	$36.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.40 / $30.16 / $36.40	Professional	26	$23.40	$30.16	$36.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $90.45 / $159.80 / $209.71	Professional	TC	$90.45	$159.80	$209.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $68.39 / $138.80 / $321.72	Facility		$68.39	$138.80	$321.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $93.06 / $150.21 / $210.80	Professional		$93.06	$150.21	$210.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.08 / $38.04 / $52.43	Professional	26	$23.08	$38.04	$52.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.59 / $115.58 / $177.47	Professional	TC	$75.59	$115.58	$177.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $423.96 / $852.22 / $1,175.01	Facility		$423.96	$852.22	$1,175.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $106.92 / $136.93 / $211.90	Professional		$106.92	$136.93	$211.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.16 / $35.99 / $51.17	Professional	26	$29.16	$35.99	$51.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $77.76 / $98.81 / $155.25	Professional	TC	$77.76	$98.81	$155.25
United Facility/Professional Professional Modifier Low / Median / High Price $101.52 / $160.09 / $239.65	Professional		$101.52	$160.09	$239.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.49 / $38.32 / $57.16	Professional	26	$27.49	$38.32	$57.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.30 / $112.58 / $201.15	Professional	TC	$73.30	$112.58	$201.15