Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $201.06 / $342.55 / $815.76	Facility		$201.06	$342.55	$815.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.54 / $60.16 / $123.52	Facility	26	$43.54	$60.16	$123.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $128.38 / $463.59	Professional		$67.84	$128.38	$463.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $36.89 / $124.53	Professional	26	$23.78	$36.89	$124.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.04 / $72.27 / $224.86	Professional	TC	$44.04	$72.27	$224.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.55 / $260.26 / $342.22	Professional		$138.55	$260.26	$342.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.35 / $61.50 / $77.76	Professional	26	$40.35	$61.50	$77.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.79 / $203.60 / $264.52	Professional	TC	$86.79	$203.60	$264.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $188.55 / $267.52 / $310.38	Professional		$188.55	$267.52	$310.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $60.44 / $68.05	Professional	26	$42.70	$60.44	$68.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $147.21 / $206.39 / $242.34	Professional	TC	$147.21	$206.39	$242.34
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $136.62 / $186.30 / $351.46	Facility		$136.62	$186.30	$351.46
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.85 / $193.03 / $361.78	Professional		$119.85	$193.03	$361.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.16 / $55.70 / $83.80	Professional	26	$42.16	$55.70	$83.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.84 / $186.73 / $277.98	Professional	TC	$139.84	$186.73	$277.98
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $127.11 / $192.96 / $233.16	Facility		$127.11	$192.96	$233.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.76 / $50.49 / $53.60	Facility	26	$38.76	$50.49	$53.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.26 / $47.79 / $56.40	Professional	26	$36.26	$47.79	$56.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $73.56 / $118.30 / $174.87	Professional	TC	$73.56	$118.30	$174.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $161.91 / $270.27 / $400.20	Facility		$161.91	$270.27	$400.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.44 / $276.66 / $340.55	Professional		$162.44	$276.66	$340.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $61.50 / $77.76	Professional	26	$42.30	$61.50	$77.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.96 / $203.60 / $264.52	Professional	TC	$102.96	$203.60	$264.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $209.48 / $285.52 / $371.66	Professional		$209.48	$285.52	$371.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $64.81 / $84.37	Professional	26	$47.88	$64.81	$84.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $161.60 / $220.71 / $287.29	Professional	TC	$161.60	$220.71	$287.29
United Facility/Professional Professional Modifier Low / Median / High Price $93.07 / $118.61 / $372.38	Professional		$93.07	$118.61	$372.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.39 / $31.13 / $85.11	Professional	26	$28.39	$31.13	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.68 / $82.36 / $287.27	Professional	TC	$64.68	$82.36	$287.27