Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.23 / $106.23 / $106.23	Facility		$106.23	$106.23	$106.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $111.44 / $111.44 / $111.44	Facility	TC	$111.44	$111.44	$111.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.88 / $93.22 / $185.90	Professional		$80.88	$93.22	$185.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.77 / $62.39 / $755.41	Professional	26	$50.77	$62.39	$755.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.10 / $33.58 / $62.92	Professional	TC	$29.10	$33.58	$62.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.13 / $64.13 / $64.13	Facility		$64.13	$64.13	$64.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.70 / $102.83 / $151.66	Professional		$42.70	$102.83	$151.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.64 / $68.02 / $102.26	Professional	26	$29.64	$68.02	$102.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.01 / $34.81 / $63.55	Professional	TC	$12.01	$34.81	$63.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $96.52 / $199.92 / $284.97	Professional		$96.52	$199.92	$284.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.73 / $119.58 / $170.44	Professional	26	$57.73	$119.58	$170.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $38.79 / $80.37 / $114.55	Professional	TC	$38.79	$80.37	$114.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $69.45 / $130.30 / $234.89	Facility		$69.45	$130.30	$234.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $137.71 / $161.47 / $320.42	Professional		$137.71	$161.47	$320.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.06 / $107.20 / $190.96	Professional	26	$96.06	$107.20	$190.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.90 / $65.11 / $129.43	Professional	TC	$46.90	$65.11	$129.43
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $117.79 / $186.26 / $203.01	Facility		$117.79	$186.26	$203.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.75 / $119.57 / $121.72	Facility	26	$85.75	$119.57	$121.72
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $38.99 / $67.09 / $83.08	Facility	TC	$38.99	$67.09	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.34 / $86.30 / $132.10	Professional	26	$70.34	$86.30	$132.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $36.40 / $50.25 / $89.30	Professional	TC	$36.40	$50.25	$89.30
Providence Facility/Professional Facility Modifier Low / Median / High Price $88.72 / $231.55 / $293.91	Facility		$88.72	$231.55	$293.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.83 / $194.66 / $293.91	Professional		$102.83	$194.66	$293.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.36 / $68.02 / $104.51	Professional	26	$36.36	$68.02	$104.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.85 / $36.86 / $72.62	Professional	TC	$18.85	$36.86	$72.62
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $610.29 / $610.29 / $613.76	Facility		$610.29	$610.29	$613.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.35 / $204.51 / $323.60	Professional		$181.35	$204.51	$323.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $122.02 / $191.84	Professional	26	$107.73	$122.02	$191.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $73.62 / $81.66 / $132.43	Professional	TC	$73.62	$81.66	$132.43
United Facility/Professional Professional Modifier Low / Median / High Price $60.20 / $62.31 / $319.37	Professional		$60.20	$62.31	$319.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.19 / $64.05 / $189.73	Professional	26	$39.19	$64.05	$189.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.01 / $24.77 / $129.63	Professional	TC	$21.01	$24.77	$129.63