Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $152.90 / $411.05 / $672.00	Facility		$152.90	$411.05	$672.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.74 / $55.02 / $143.18	Facility	26	$38.74	$55.02	$143.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $109.07 / $303.85 / $627.00	Facility	TC	$109.07	$303.85	$627.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.65 / $118.44 / $491.00	Professional		$92.65	$118.44	$491.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $39.02 / $140.05	Professional	26	$25.26	$39.02	$140.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.43 / $85.19 / $169.82	Professional	TC	$61.43	$85.19	$169.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.27 / $301.52 / $367.38	Facility		$66.27	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.71 / $195.22 / $268.52	Professional		$102.71	$195.22	$268.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.90 / $57.73 / $81.65	Professional	26	$31.90	$57.73	$81.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.93 / $135.33 / $176.02	Professional	TC	$70.93	$135.33	$176.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $166.29 / $193.79 / $234.99	Professional		$166.29	$193.79	$234.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.27 / $61.85 / $71.37	Professional	26	$52.27	$61.85	$71.37
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $113.21 / $132.47 / $163.62	Professional	TC	$113.21	$132.47	$163.62
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $89.57 / $173.48 / $297.12	Facility		$89.57	$173.48	$297.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $138.77 / $158.00 / $269.39	Professional		$138.77	$158.00	$269.39
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.30 / $55.04 / $88.07	Professional	26	$44.30	$55.04	$88.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.46 / $122.76 / $187.78	Professional	TC	$94.46	$122.76	$187.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $125.97 / $171.40 / $199.55	Facility		$125.97	$171.40	$199.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $54.70 / $56.28	Facility	26	$41.16	$54.70	$56.28
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $91.58 / $116.70 / $132.31	Facility	TC	$91.58	$116.70	$132.31
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $86.94	Professional		$78.25	$78.25	$86.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.29 / $48.72 / $59.01	Professional	26	$38.29	$48.72	$59.01
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $82.54 / $115.00 / $138.18	Professional	TC	$82.54	$115.00	$138.18
Providence Facility/Professional Facility Modifier Low / Median / High Price $100.64 / $215.40 / $273.95	Facility		$100.64	$215.40	$273.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $156.16 / $202.62 / $255.65	Professional		$156.16	$202.62	$255.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.03 / $60.83 / $80.64	Professional	26	$37.03	$60.83	$80.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $81.54 / $139.75 / $182.11	Professional	TC	$81.54	$139.75	$182.11
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $160.51 / $209.27 / $251.09	Professional		$160.51	$209.27	$251.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $67.28 / $79.59	Professional	26	$51.24	$67.28	$79.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $112.09 / $145.22 / $171.50	Professional	TC	$112.09	$145.22	$171.50
United Facility/Professional Professional Modifier Low / Median / High Price $92.75 / $104.84 / $265.64	Professional		$92.75	$104.84	$265.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.95 / $37.03 / $87.90	Professional	26	$29.95	$37.03	$87.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.80 / $80.25 / $187.50	Professional	TC	$62.80	$80.25	$187.50