Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $524.81 / $794.33	Facility		$123.03	$524.81	$794.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $83.18 / $104.71	Facility	26	$52.48	$83.18	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $204.17 / $676.08	Professional		$100.00	$204.17	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $60.26 / $181.97	Professional	26	$34.67	$60.26	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $102.33 / $245.47	Professional	TC	$67.61	$102.33	$245.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $229.09 / $331.13	Facility		$87.10	$229.09	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $234.42 / $338.84	Professional		$128.82	$234.42	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $72.44 / $107.15	Professional	26	$40.74	$72.44	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $158.49 / $229.09	Professional	TC	$85.11	$158.49	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $302.00	Professional		$194.98	$245.47	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $77.62 / $93.33	Professional	26	$60.26	$77.62	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $165.96 / $204.17	Professional	TC	$134.90	$165.96	$204.17
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $199.53 / $602.56	Facility		$112.20	$199.53	$602.56
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $74.13 / $104.71	Facility	26	$52.48	$74.13	$104.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $223.87 / $354.81	Professional		$134.90	$223.87	$354.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $120.23	Professional	26	$39.81	$75.86	$120.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $158.49 / $218.78	Professional	TC	$89.13	$158.49	$218.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $229.09 / $257.04	Facility		$190.55	$229.09	$257.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $75.86 / $77.62	Facility	26	$61.66	$75.86	$77.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $67.61 / $79.43	Professional	26	$46.77	$67.61	$79.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $147.91 / $190.55	Professional	TC	$107.15	$147.91	$190.55
Providence Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $177.83 / $302.00	Facility		$112.20	$177.83	$302.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $257.04 / $338.84	Professional		$190.55	$257.04	$338.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $77.62 / $107.15	Professional	26	$51.29	$77.62	$107.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $229.09	Professional	TC	$114.82	$173.78	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $371.54 / $467.74	Facility		$295.12	$371.54	$467.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $316.23	Professional		$208.93	$257.04	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $104.71	Professional	26	$69.18	$81.28	$104.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $177.83 / $213.80	Professional	TC	$144.54	$177.83	$213.80
United Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $389.05 / $512.86	Facility		$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $144.54 / $323.59	Professional		$125.89	$144.54	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $43.65 / $102.33	Professional	26	$38.90	$43.65	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $95.50 / $213.80	Professional	TC	$83.18	$95.50	$213.80