Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $251.19 / $831.76	Facility		$147.91	$251.19	$831.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $33.11 / $38.90	Facility	26	$20.89	$33.11	$38.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $295.12	Professional		$79.43	$112.20	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $20.89 / $83.18	Professional	26	$12.88	$20.89	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $85.11 / $181.97	Professional	TC	$63.10	$85.11	$181.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $645.65 / $831.76	Facility		$97.72	$645.65	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $186.21 / $295.12	Professional		$87.10	$186.21	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $29.51 / $45.71	Professional	26	$16.98	$29.51	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $158.49 / $251.19	Professional	TC	$70.79	$158.49	$251.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $229.09 / $281.84	Professional		$204.17	$229.09	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $33.11 / $39.81	Professional	26	$29.51	$33.11	$39.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $194.98 / $239.88	Professional	TC	$173.78	$194.98	$239.88
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $147.91 / $234.42	Facility		$87.10	$147.91	$234.42
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $25.70 / $38.90	Facility	26	$20.89	$25.70	$38.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $302.00	Professional		$109.65	$190.55	$302.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $31.62 / $45.71	Professional	26	$17.78	$31.62	$45.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $173.78 / $251.19	Professional	TC	$89.13	$173.78	$251.19
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $181.97 / $208.93	Facility		$128.82	$181.97	$208.93
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $30.20 / $31.62	Facility	26	$25.12	$30.20	$31.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $33.11	Professional	26	$18.62	$27.54	$33.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $177.83	Professional	TC	$85.11	$117.49	$177.83
Providence Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $147.91 / $263.03	Facility		$91.20	$147.91	$263.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $3.80 / $17.78 / $25.12	Facility	26	$3.80	$17.78	$25.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $204.17 / $302.00	Professional		$144.54	$204.17	$302.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $33.11 / $45.71	Professional	26	$21.38	$33.11	$45.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $251.19	Professional	TC	$97.72	$154.88	$251.19
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $776.25 / $977.24	Facility		$660.69	$776.25	$977.24
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $208.93 / $275.42	Professional		$151.36	$208.93	$275.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $32.36 / $41.69	Professional	26	$27.54	$32.36	$41.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $169.82 / $234.42	Professional	TC	$125.89	$169.82	$234.42
United Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $891.25 / $1,174.90	Facility		$724.44	$891.25	$1,174.90
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $269.15	Professional		$83.18	$112.20	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $20.42 / $43.65	Professional	26	$16.22	$20.42	$43.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $95.50 / $234.42	Professional	TC	$66.07	$95.50	$234.42