Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.13 / $195.03 / $653.26	Facility		$77.13	$195.03	$653.26
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $80.90 / $80.90 / $80.90	Facility	TC	$80.90	$80.90	$80.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.44 / $35.63 / $70.81	Professional		$27.44	$35.63	$70.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $11.65 / $36.20	Professional	26	$8.69	$11.65	$36.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.50 / $36.61 / $53.41	Professional	TC	$25.50	$36.61	$53.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $49.93 / $49.93 / $49.93	Facility		$49.93	$49.93	$49.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.86 / $43.47 / $76.16	Professional		$25.86	$43.47	$76.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.35 / $12.45 / $18.38	Professional	26	$5.35	$12.45	$18.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.19 / $31.02 / $56.17	Professional	TC	$19.19	$31.02	$56.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.70 / $84.30 / $120.16	Professional		$40.70	$84.30	$120.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $10.51 / $21.77 / $31.03	Professional	26	$10.51	$21.77	$31.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.19 / $62.53 / $89.13	Professional	TC	$30.19	$62.53	$89.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $27.99 / $54.95 / $132.75	Facility		$27.99	$54.95	$132.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $38.97 / $74.93 / $135.79	Professional		$38.97	$74.93	$135.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.61 / $19.50 / $35.00	Professional	26	$17.61	$19.50	$35.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.60 / $55.62 / $100.79	Professional	TC	$45.60	$55.62	$100.79
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $56.20 / $82.00 / $92.00	Facility		$56.20	$82.00	$92.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $13.67 / $21.76 / $22.44	Facility	26	$13.67	$21.76	$22.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $33.36 / $57.49 / $64.31	Facility	TC	$33.36	$57.49	$64.31
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $21.44 / $25.16	Professional	26	$14.40	$21.44	$25.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $37.39 / $64.31 / $76.00	Professional	TC	$37.39	$64.31	$76.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $42.87 / $99.54 / $125.13	Facility		$42.87	$99.54	$125.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $43.47 / $82.53 / $121.70	Professional		$43.47	$82.53	$121.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.67 / $12.45 / $19.05	Professional	26	$6.67	$12.45	$19.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.19 / $31.02 / $61.68	Professional	TC	$19.19	$31.02	$61.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $203.33 / $203.33 / $204.49	Facility		$203.33	$203.33	$204.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $76.01 / $83.02 / $137.77	Professional		$76.01	$83.02	$137.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $22.50 / $35.24	Professional	26	$19.75	$22.50	$35.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.26 / $60.56 / $102.53	Professional	TC	$56.26	$60.56	$102.53
United Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $41.86 / $133.87	Professional		$25.12	$41.86	$133.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.15 / $11.91 / $34.78	Professional	26	$7.15	$11.91	$34.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.97 / $20.47 / $99.09	Professional	TC	$17.97	$20.47	$99.09