Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.23 / $654.02 / $902.91	Facility		$89.23	$654.02	$902.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $89.23 / $89.23 / $89.23	Facility	TC	$89.23	$89.23	$89.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $76.58 / $239.01	Professional		$51.88	$76.58	$239.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.70 / $66.59 / $256.37	Professional	26	$31.70	$66.59	$256.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.69 / $38.06 / $64.34	Professional	52	$24.69	$38.06	$64.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $36.77 / $104.85	Professional	TC	$28.37	$36.77	$104.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $56.25 / $56.25 / $56.25	Facility		$56.25	$56.25	$56.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.95 / $72.51 / $176.28	Professional		$47.95	$72.51	$176.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.30 / $40.72 / $63.28	Professional	26	$18.30	$40.72	$63.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.03 / $31.78 / $113.00	Professional	TC	$28.03	$31.78	$113.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $68.69 / $142.28 / $202.80	Professional		$68.69	$142.28	$202.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $71.81 / $102.36	Professional	26	$34.67	$71.81	$102.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $34.02 / $70.47 / $100.44	Professional	TC	$34.02	$70.47	$100.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $47.46 / $92.73 / $169.63	Facility		$47.46	$92.73	$169.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $96.00 / $129.78 / $228.12	Professional		$96.00	$129.78	$228.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $72.36 / $114.57	Professional	26	$57.63	$72.36	$114.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.11 / $87.00 / $114.57	Professional	TC	$57.11	$87.00	$114.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $93.99 / $133.62 / $150.52	Facility		$93.99	$133.62	$150.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.43 / $71.81 / $73.44	Facility	26	$52.43	$71.81	$73.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $40.21 / $64.80 / $71.69	Facility	TC	$40.21	$64.80	$71.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $50.29 / $69.38 / $88.56	Professional	26	$50.29	$69.38	$88.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $38.93 / $56.65 / $118.90	Professional	TC	$38.93	$56.65	$118.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $62.41 / $166.00 / $208.55	Facility		$62.41	$166.00	$208.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.83 / $137.80 / $207.76	Professional		$75.83	$137.80	$207.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.19 / $40.72 / $69.38	Professional	26	$19.19	$40.72	$69.38
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $77.18 / $80.54 / $85.26	Professional	52	$77.18	$80.54	$85.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.52 / $38.01 / $128.18	Professional	TC	$29.52	$38.01	$128.18
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 $126.88 / $141.54 / $229.62	Professional		$126.88	$141.54	$229.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.64 / $73.62 / $115.34	Professional	26	$64.64	$73.62	$115.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $62.24 / $66.12 / $114.28	Professional	TC	$62.24	$66.12	$114.28
United Facility/Professional Professional Modifier Low / Median / High Price $42.88 / $107.19 / $223.45	Professional		$42.88	$107.19	$223.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $59.01 / $113.84	Professional	26	$23.61	$59.01	$113.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.27 / $32.11 / $115.43	Professional	TC	$19.27	$32.11	$115.43