Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $204.17	Facility		$194.98	$194.98	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $69.18 / $190.55	Professional		$51.29	$69.18	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $25.70 / $64.57	Professional	26	$18.20	$25.70	$64.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $45.71 / $93.33	Professional	TC	$33.11	$45.71	$93.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Facility		$75.86	$75.86	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $61.66 / $117.49	Professional		$32.36	$61.66	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $18.62 / $37.15	Professional	26	$11.75	$18.62	$37.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $43.65 / $75.86	Professional	TC	$18.62	$43.65	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $138.04 / $194.98	Professional		$67.61	$138.04	$194.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $41.69 / $60.26	Professional	26	$20.89	$41.69	$60.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $95.50 / $134.90	Professional	TC	$46.77	$95.50	$134.90
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $85.11 / $158.49	Facility		$53.70	$85.11	$158.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $218.78	Professional		$75.86	$125.89	$218.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $48.98 / $70.79	Professional	26	$22.91	$48.98	$70.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $77.62 / $144.54	Professional	TC	$38.90	$77.62	$144.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $123.03 / $141.25	Facility		$85.11	$123.03	$141.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $42.66 / $50.12	Facility	26	$35.48	$42.66	$50.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $36.31 / $50.12	Professional	26	$26.30	$36.31	$50.12
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $69.18 / $104.71	Professional	TC	$44.67	$69.18	$104.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $93.33 / $169.82	Facility		$58.88	$93.33	$169.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $125.89 / $204.17	Professional		$50.12	$125.89	$204.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $23.44 / $63.10	Professional	26	$13.18	$23.44	$63.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $47.86 / $141.25	Professional	TC	$22.39	$47.86	$141.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $144.54	Facility		$141.25	$141.25	$144.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $128.82 / $208.93	Professional		$81.28	$128.82	$208.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $44.67 / $69.18	Professional	26	$25.70	$44.67	$69.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $83.18 / $141.25	Professional	TC	$56.23	$83.18	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $63.10 / $208.93	Professional		$38.02	$63.10	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.44 / $69.18	Professional	26	$14.13	$23.44	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.81 / $138.04	Professional	TC	$23.99	$39.81	$138.04