Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.96 / $474.32 / $792.30	Facility		$97.96	$474.32	$792.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.50 / $59.73 / $97.99	Facility	26	$41.50	$59.73	$97.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.17 / $161.00 / $348.57	Professional		$60.17	$161.00	$348.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $41.51 / $162.00	Professional	26	$29.01	$41.51	$162.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.00 / $149.44 / $187.42	Professional	TC	$27.00	$149.44	$187.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.34 / $137.55 / $248.01	Professional		$79.34	$137.55	$248.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.44 / $63.62 / $89.42	Professional	26	$36.44	$63.62	$89.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.08 / $67.58 / $151.96	Professional	TC	$36.08	$67.58	$151.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $113.15 / $131.87 / $157.49	Professional		$113.15	$131.87	$157.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $56.58 / $67.14 / $77.26	Professional	26	$56.58	$67.14	$77.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.54 / $64.98 / $80.25	Professional	TC	$55.54	$64.98	$80.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $58.69 / $125.45 / $430.04	Facility		$58.69	$125.45	$430.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $90.72 / $122.04 / $310.86	Professional		$90.72	$122.04	$310.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $61.38 / $95.48	Professional	26	$48.03	$61.38	$95.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $59.00 / $92.30	Professional	TC	$46.43	$59.00	$92.30
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $82.85 / $114.57 / $276.66	Facility		$82.85	$114.57	$276.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $46.55 / $59.39 / $62.22	Facility	26	$46.55	$59.39	$62.22
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $55.46 / $66.75	Professional	26	$37.79	$55.46	$66.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.18 / $52.93 / $288.33	Professional	TC	$33.18	$52.93	$288.33
Providence Facility/Professional Facility Modifier Low / Median / High Price $70.58 / $146.51 / $408.00	Facility		$70.58	$146.51	$408.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $101.48 / $135.19 / $181.83	Professional		$101.48	$135.19	$181.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.77 / $66.01 / $87.68	Professional	26	$40.77	$66.01	$87.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.61 / $67.27 / $147.58	Professional	TC	$39.61	$67.27	$147.58
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.14 / $138.06 / $164.87	Professional		$104.14	$138.06	$164.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.13 / $72.23 / $85.28	Professional	26	$55.13	$72.23	$85.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.27 / $69.05 / $79.59	Professional	TC	$50.27	$69.05	$79.59
United Facility/Professional Professional Modifier Low / Median / High Price $58.47 / $76.01 / $193.13	Professional		$58.47	$76.01	$193.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.47 / $35.56 / $93.24	Professional	26	$32.47	$35.56	$93.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.99 / $42.49 / $107.30	Professional	TC	$25.99	$42.49	$107.30