Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.03 / $220.23 / $835.47	Facility		$149.03	$220.23	$835.47
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.54 / $32.97 / $78.01	Facility	26	$21.54	$32.97	$78.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $115.45 / $272.98	Professional		$81.59	$115.45	$272.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.73 / $18.30 / $84.00	Professional	26	$13.73	$18.30	$84.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $86.78 / $222.34	Professional	TC	$67.40	$86.78	$222.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $98.56 / $636.79 / $835.09	Facility		$98.56	$636.79	$835.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.75 / $17.75 / $17.75	Facility	26	$17.75	$17.75	$17.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $88.17 / $180.27 / $291.63	Professional		$88.17	$180.27	$291.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.53 / $30.38 / $45.23	Professional	26	$18.53	$30.38	$45.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.37 / $154.52 / $251.70	Professional	TC	$73.37	$154.52	$251.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $200.67 / $239.15 / $278.39	Professional		$200.67	$239.15	$278.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.56 / $35.33 / $39.77	Professional	26	$29.56	$35.33	$39.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $170.20 / $203.22 / $238.65	Professional	TC	$170.20	$203.22	$238.65
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $87.44 / $175.16 / $238.80	Facility		$87.44	$175.16	$238.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $130.05 / $171.09 / $320.22	Professional		$130.05	$171.09	$320.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $31.40 / $46.77	Professional	26	$24.55	$31.40	$46.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.72 / $172.02 / $273.72	Professional	TC	$126.72	$172.02	$273.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.21 / $168.72 / $209.04	Facility		$112.21	$168.72	$209.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.03 / $30.47 / $31.49	Facility	26	$23.03	$30.47	$31.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.09 / $26.22 / $33.14	Professional	26	$18.09	$26.22	$33.14
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $83.90 / $109.75 / $152.76	Professional	TC	$83.90	$109.75	$152.76
Providence Facility/Professional Facility Modifier Low / Median / High Price $103.24 / $213.13 / $320.44	Facility		$103.24	$213.13	$320.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.75 / $17.75 / $17.75	Facility	26	$17.75	$17.75	$17.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $140.41 / $212.57 / $302.10	Professional		$140.41	$212.57	$302.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $31.52 / $45.24	Professional	26	$20.39	$31.52	$45.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.68 / $170.85 / $251.70	Professional	TC	$97.68	$170.85	$251.70
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $656.85 / $782.93 / $962.78	Facility		$656.85	$782.93	$962.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $157.47 / $213.72 / $290.05	Professional		$157.47	$213.72	$290.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.53 / $33.25 / $43.59	Professional	26	$27.53	$33.25	$43.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.54 / $182.21 / $249.00	Professional	TC	$128.54	$182.21	$249.00
United Facility/Professional Facility Modifier Low / Median / High Price $132.53 / $132.53 / $132.53	Facility		$132.53	$132.53	$132.53
United Facility/Professional Professional Modifier Low / Median / High Price $82.90 / $106.74 / $282.77	Professional		$82.90	$106.74	$282.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.10 / $20.62 / $47.47	Professional	26	$16.10	$20.62	$47.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.03 / $91.15 / $235.31	Professional	TC	$66.03	$91.15	$235.31