Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $123.03 / $346.74	Facility		$95.50	$123.03	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $51.29 / $117.49	Professional		$25.70	$51.29	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $12.02 / $28.84	Professional	26	$5.01	$12.02	$28.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $50.12	Professional	TC	$17.38	$25.12	$50.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $41.69 / $41.69	Facility		$41.69	$41.69	$41.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $29.51 / $57.54	Professional		$15.85	$29.51	$57.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.47 / $5.62 / $10.96	Professional	26	$3.47	$5.62	$10.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $23.99 / $46.77	Professional	TC	$12.30	$23.99	$46.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $64.57 / $93.33	Professional		$32.36	$64.57	$93.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $13.18 / $18.62	Professional	26	$6.61	$13.18	$18.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $51.29 / $74.13	Professional	TC	$25.70	$51.29	$74.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $12.02 / $50.12 / $154.88	Facility		$12.02	$50.12	$154.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $58.88 / $107.15	Professional		$42.66	$58.88	$107.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $12.02 / $21.88	Professional	26	$6.61	$12.02	$21.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $46.77 / $85.11	Professional	TC	$25.70	$46.77	$85.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $63.10 / $72.44	Facility		$50.12	$63.10	$72.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $13.18 / $14.13	Facility	26	$10.96	$13.18	$14.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.48 / $14.13	Professional	26	$7.94	$11.48	$14.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $44.67 / $67.61	Professional	TC	$28.84	$44.67	$67.61
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $50.12 / $89.13	Facility		$29.51	$50.12	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $58.88 / $97.72	Professional		$29.51	$58.88	$97.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $4.07 / $6.92 / $19.50	Professional	26	$4.07	$6.92	$19.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $28.18 / $77.62	Professional	TC	$14.13	$28.18	$77.62
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $107.15	Facility		$104.71	$104.71	$107.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $63.10 / $104.71	Professional		$39.81	$63.10	$104.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.49 / $21.38	Professional	26	$7.94	$13.49	$21.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $50.12 / $83.18	Professional	TC	$31.62	$50.12	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $31.62 / $102.33	Professional		$19.05	$31.62	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.27 / $7.24 / $20.89	Professional	26	$4.27	$7.24	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $23.99 / $87.10	Professional	TC	$14.45	$23.99	$87.10