Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.57 / $140.82 / $320.64	Facility		$59.57	$140.82	$320.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.32 / $24.21 / $48.46	Facility	26	$18.32	$24.21	$48.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $41.08 / $158.01	Professional		$23.99	$41.08	$158.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $14.90 / $57.59	Professional	26	$9.41	$14.90	$57.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $27.86 / $62.29	Professional	TC	$19.76	$27.86	$62.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.83 / $223.86 / $304.19	Facility		$28.83	$223.86	$304.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.34 / $64.69 / $101.29	Professional		$34.34	$64.69	$101.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $21.04 / $30.91	Professional	26	$12.01	$21.04	$30.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.46 / $46.71 / $73.17	Professional	TC	$23.46	$46.71	$73.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.41 / $86.06 / $99.54	Professional		$72.41	$86.06	$99.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.48 / $24.54 / $27.62	Professional	26	$20.48	$24.54	$27.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $51.31 / $61.26 / $71.89	Professional	TC	$51.31	$61.26	$71.89
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.43 / $62.10 / $89.78	Facility		$32.43	$62.10	$89.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $48.50 / $59.78 / $110.40	Professional		$48.50	$59.78	$110.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $20.91 / $32.52	Professional	26	$17.07	$20.91	$32.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.60 / $51.09 / $80.31	Professional	TC	$39.60	$51.09	$80.31
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $45.08 / $62.98 / $73.70	Facility		$45.08	$62.98	$73.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $15.50 / $20.52 / $21.44	Facility	26	$15.50	$20.52	$21.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $13.20 / $18.60 / $24.00	Professional	26	$13.20	$18.60	$24.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.80 / $37.11 / $51.30	Professional	TC	$28.80	$37.11	$51.30
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.82 / $79.68 / $109.87	Facility		$36.82	$79.68	$109.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.95 / $11.95 / $11.95	Facility	26	$11.95	$11.95	$11.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.28 / $76.87 / $104.50	Professional		$54.28	$76.87	$104.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $21.77 / $30.91	Professional	26	$14.36	$21.77	$30.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.47 / $51.14 / $74.09	Professional	TC	$32.47	$51.14	$74.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $201.89 / $281.32 / $339.89	Facility		$201.89	$281.32	$339.89
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 $60.16 / $76.18 / $100.99	Professional		$60.16	$76.18	$100.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $22.64 / $30.32	Professional	26	$19.14	$22.64	$30.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $40.26 / $54.12 / $71.87	Professional	TC	$40.26	$54.12	$71.87
United Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $43.94 / $103.36	Professional		$32.29	$43.94	$103.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.98 / $12.38 / $33.08	Professional	26	$10.98	$12.38	$33.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.63 / $29.56 / $70.28	Professional	TC	$19.63	$29.56	$70.28