Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $209.40 / $367.10 / $769.47	Facility		$209.40	$367.10	$769.47
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $183.55 / $183.55 / $183.55	Facility	TC	$183.55	$183.55	$183.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.21 / $76.18 / $115.30	Professional		$42.21	$76.18	$115.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.39 / $60.80	Professional	26	$10.00	$22.39	$60.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.66 / $68.56 / $129.96	Professional	TC	$45.66	$68.56	$129.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $110.90 / $110.90 / $110.90	Facility		$110.90	$110.90	$110.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.22 / $75.31 / $126.60	Professional		$29.22	$75.31	$126.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.86 / $12.80 / $19.62	Professional	26	$5.86	$12.80	$19.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.36 / $62.51 / $109.81	Professional	TC	$23.36	$62.51	$109.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $78.34 / $162.29 / $231.32	Professional		$78.34	$162.29	$231.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.16 / $23.12 / $32.95	Professional	26	$11.16	$23.12	$32.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $67.18 / $139.15 / $198.34	Professional	TC	$67.18	$139.15	$198.34
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.36 / $90.12 / $179.53	Facility		$38.36	$90.12	$179.53
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.53 / $131.29 / $260.99	Professional		$93.53	$131.29	$260.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.68 / $21.45 / $37.13	Professional	26	$18.68	$21.45	$37.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.78 / $112.61 / $223.86	Professional	TC	$89.78	$112.61	$223.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $86.03 / $135.66 / $166.83	Facility		$86.03	$135.66	$166.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.07 / $22.47 / $23.45	Facility	26	$14.07	$22.47	$23.45
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $71.95 / $119.93 / $143.38	Facility	TC	$71.95	$119.93	$143.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $17.85 / $25.83	Professional	26	$16.35	$17.85	$25.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.61 / $94.48 / $146.86	Professional	TC	$81.61	$94.48	$146.86
Providence Facility/Professional Facility Modifier Low / Median / High Price $74.33 / $184.31 / $241.53	Facility		$74.33	$184.31	$241.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.73 / $156.16 / $237.41	Professional		$80.73	$156.16	$237.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.07 / $12.80 / $20.21	Professional	26	$7.07	$12.80	$20.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.31 / $62.51 / $125.49	Professional	TC	$31.31	$62.51	$125.49
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $138.51 / $138.51 / $139.30	Facility		$138.51	$138.51	$139.30
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $146.03 / $159.52 / $265.93	Professional		$146.03	$159.52	$265.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $20.95 / $23.86 / $37.38	Professional	26	$20.95	$23.86	$37.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.09 / $135.66 / $228.55	Professional	TC	$125.09	$135.66	$228.55
United Facility/Professional Professional Modifier Low / Median / High Price $46.34 / $77.23 / $257.16	Professional		$46.34	$77.23	$257.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.55 / $12.63 / $36.89	Professional	26	$7.55	$12.63	$36.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $64.59 / $220.27	Professional	TC	$38.76	$64.59	$220.27