Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $186.90 / $434.58 / $911.73	Facility		$186.90	$434.58	$911.73
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $227.93 / $227.93 / $227.93	Facility	TC	$227.93	$227.93	$227.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.93 / $85.92 / $184.46	Professional		$54.93	$85.92	$184.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.09 / $27.22 / $109.99	Professional	26	$20.09	$27.22	$109.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $83.35 / $150.60	Professional	TC	$44.43	$83.35	$150.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $135.63 / $135.63 / $135.63	Facility		$135.63	$135.63	$135.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.39 / $103.67 / $171.09	Professional		$40.39	$103.67	$171.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.19 / $28.64 / $44.47	Professional	26	$13.19	$28.64	$44.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.20 / $75.03 / $133.97	Professional	TC	$27.20	$75.03	$133.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $106.76 / $221.13 / $315.20	Professional		$106.76	$221.13	$315.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.69 / $51.14 / $72.89	Professional	26	$24.69	$51.14	$72.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $82.06 / $169.97 / $242.27	Professional	TC	$82.06	$169.97	$242.27
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $75.01 / $123.81 / $239.87	Facility		$75.01	$123.81	$239.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $134.88 / $178.79 / $355.42	Professional		$134.88	$178.79	$355.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.10 / $48.00 / $81.70	Professional	26	$41.10	$48.00	$81.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.52 / $137.69 / $273.72	Professional	TC	$104.52	$137.69	$273.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $119.39 / $186.26 / $226.46	Facility		$119.39	$186.26	$226.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $30.95 / $50.37 / $51.68	Facility	26	$30.95	$50.37	$51.68
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $88.44 / $145.35 / $174.87	Facility	TC	$88.44	$145.35	$174.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $45.23 / $57.75	Professional	26	$34.65	$45.23	$57.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $93.97 / $128.80 / $182.29	Professional	TC	$93.97	$128.80	$182.29
Providence Facility/Professional Facility Modifier Low / Median / High Price $101.20 / $256.33 / $327.86	Facility		$101.20	$256.33	$327.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.67 / $214.40 / $327.86	Professional		$103.67	$214.40	$327.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.76 / $28.64 / $44.56	Professional	26	$15.76	$28.64	$44.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.39 / $75.42 / $153.11	Professional	TC	$39.39	$75.42	$153.11
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 $200.50 / $220.87 / $360.98	Professional		$200.50	$220.87	$360.98
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.08 / $52.49 / $82.24	Professional	26	$46.08	$52.49	$82.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $154.41 / $168.38 / $278.75	Professional	TC	$154.41	$168.38	$278.75
United Facility/Professional Professional Modifier Low / Median / High Price $64.31 / $67.51 / $353.08	Professional		$64.31	$67.51	$353.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $27.79 / $81.15	Professional	26	$16.67	$27.79	$81.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $79.40 / $271.93	Professional	TC	$47.64	$79.40	$271.93