Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $501.19 / $933.25	Facility		$100.00	$501.19	$933.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $66.07 / $75.86	Facility	26	$41.69	$66.07	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $144.54 / $794.33	Professional		$53.70	$144.54	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $45.71 / $169.82	Professional	26	$28.18	$45.71	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $44.67 / $181.97	Professional	TC	$21.38	$44.67	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $128.82 / $331.13	Professional		$67.61	$128.82	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $57.54 / $87.10	Professional	26	$33.88	$57.54	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $61.66 / $234.42	Professional	TC	$31.62	$61.66	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $131.83 / $158.49	Professional		$107.15	$131.83	$158.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $77.62	Professional	26	$51.29	$64.57	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $70.79 / $83.18	Professional	TC	$57.54	$70.79	$83.18
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $117.49 / $489.78	Facility		$58.88	$117.49	$489.78
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $51.29 / $83.18	Facility	26	$41.69	$51.29	$83.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $131.83 / $309.03	Professional		$70.79	$131.83	$309.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $61.66 / $91.20	Professional	26	$32.36	$61.66	$91.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $67.61 / $154.88	Professional	TC	$38.02	$67.61	$154.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $114.82 / $263.03	Facility		$95.50	$114.82	$263.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $58.88 / $61.66	Facility	26	$48.98	$58.88	$61.66
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Professional		$263.03	$263.03	$263.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $67.61	Professional	26	$38.02	$56.23	$67.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $57.54 / $281.84	Professional	TC	$33.11	$57.54	$281.84
Providence Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $114.82 / $346.74	Facility		$61.66	$114.82	$346.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $309.03	Professional		$97.72	$128.82	$309.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $85.11	Professional	26	$42.66	$63.10	$85.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $323.59	Professional	TC	$42.66	$64.57	$323.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $123.03 / $165.96	Professional		$104.71	$123.03	$165.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $64.57 / $83.18	Professional	26	$54.95	$64.57	$83.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $60.26 / $81.28	Professional	TC	$48.98	$60.26	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $199.53	Professional		$58.88	$95.50	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $35.48 / $85.11	Professional	26	$32.36	$35.48	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $151.36	Professional	TC	$25.70	$43.65	$151.36