Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $356.44 / $4,684.68 / $8,728.00	Facility		$356.44	$4,684.68	$8,728.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.26 / $87.37 / $96.54	Facility	26	$79.26	$87.37	$96.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.68 / $259.19 / $583.02	Professional		$152.68	$259.19	$583.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.25 / $51.24 / $126.11	Professional	26	$40.25	$51.24	$126.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.17 / $156.40 / $415.45	Professional	TC	$98.17	$156.40	$415.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.79 / $429.82 / $557.58	Professional		$175.79	$429.82	$557.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.30 / $89.12 / $127.81	Professional	26	$58.30	$89.12	$127.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.67 / $344.42 / $442.52	Professional	TC	$114.67	$344.42	$442.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.07 / $390.46 / $452.81	Professional		$275.07	$390.46	$452.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.74 / $88.71 / $99.88	Professional	26	$62.74	$88.71	$99.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $214.38 / $300.52 / $352.91	Professional	TC	$214.38	$300.52	$352.91
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $259.19 / $288.95 / $557.26	Facility		$259.19	$288.95	$557.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $170.34 / $281.91 / $528.38	Professional		$170.34	$281.91	$528.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.45 / $88.95 / $124.15	Professional	26	$62.45	$88.95	$124.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.35 / $289.61 / $404.23	Professional	TC	$203.35	$289.61	$404.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $167.49 / $273.82 / $379.89	Facility		$167.49	$273.82	$379.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.20 / $76.43 / $80.92	Facility	26	$56.20	$76.43	$80.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.88 / $66.06 / $87.00	Professional	26	$49.88	$66.06	$87.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $92.92 / $135.34 / $269.68	Professional	TC	$92.92	$135.34	$269.68
Providence Facility/Professional Facility Modifier Low / Median / High Price $259.19 / $298.97 / $495.98	Facility		$259.19	$298.97	$495.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $221.13 / $435.76 / $562.40	Professional		$221.13	$435.76	$562.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.12 / $89.12 / $115.06	Professional	26	$61.12	$89.12	$115.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.25 / $344.42 / $442.52	Professional	TC	$128.25	$344.42	$442.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $355.49 / $465.22 / $594.78	Professional		$355.49	$465.22	$594.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $71.95 / $96.00 / $122.73	Professional	26	$71.95	$96.00	$122.73
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $283.52 / $369.23 / $472.05	Professional	TC	$283.52	$369.23	$472.05
United Facility/Professional Facility Modifier Low / Median / High Price $376.00 / $3,290.00 / $6,216.00	Facility		$376.00	$3,290.00	$6,216.00
United Facility/Professional Professional Modifier Low / Median / High Price $209.19 / $299.64 / $614.94	Professional		$209.19	$299.64	$614.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.32 / $85.66 / $124.48	Professional	26	$60.32	$85.66	$124.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.72 / $231.15 / $490.46	Professional	TC	$133.72	$231.15	$490.46