Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $159.22 / $345.82 / $960.33	Facility		$159.22	$345.82	$960.33
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $172.91 / $172.91 / $172.91	Facility	TC	$172.91	$172.91	$172.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.79 / $73.44 / $157.62	Professional		$53.79	$73.44	$157.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $51.08 / $338.69	Professional	26	$19.98	$51.08	$338.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.46 / $56.98 / $176.76	Professional	TC	$29.46	$56.98	$176.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $108.80 / $108.80 / $108.80	Facility		$108.80	$108.80	$108.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.53 / $98.81 / $137.27	Professional		$33.53	$98.81	$137.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $30.51 / $44.68	Professional	26	$11.22	$30.51	$44.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.31 / $68.30 / $98.18	Professional	TC	$22.31	$68.30	$98.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $92.32 / $191.22 / $272.57	Professional		$92.32	$191.22	$272.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $54.48 / $77.65	Professional	26	$26.30	$54.48	$77.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $66.02 / $136.75 / $194.92	Professional	TC	$66.02	$136.75	$194.92
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $69.23 / $95.83 / $222.44	Facility		$69.23	$95.83	$222.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.23 / $161.82 / $306.61	Professional		$67.23	$161.82	$306.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.51 / $48.00 / $86.99	Professional	26	$39.51	$48.00	$86.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.77 / $121.20 / $219.63	Professional	TC	$99.77	$121.20	$219.63
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.34 / $172.19 / $182.24	Facility		$109.34	$172.19	$182.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.36 / $54.27 / $55.61	Facility	26	$33.36	$54.27	$55.61
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $84.30 / $119.93 / $127.97	Facility	TC	$84.30	$119.93	$127.97
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $34.19 / $38.93 / $60.52	Professional	26	$34.19	$38.93	$60.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $81.61 / $105.05 / $135.00	Professional	TC	$81.61	$105.05	$135.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $95.83 / $211.32 / $263.83	Facility		$95.83	$211.32	$263.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.81 / $169.62 / $255.55	Professional		$98.81	$169.62	$255.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $12.62 / $30.51 / $47.35	Professional	26	$12.62	$30.51	$47.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.34 / $68.30 / $112.20	Professional	TC	$28.34	$68.30	$112.20
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $153.81 / $183.38 / $290.50	Professional		$153.81	$183.38	$290.50
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $55.90 / $87.40	Professional	26	$49.08	$55.90	$87.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $104.74 / $127.48 / $201.64	Professional	TC	$104.74	$127.48	$201.64
United Facility/Professional Professional Modifier Low / Median / High Price $56.51 / $115.79 / $270.88	Professional		$56.51	$115.79	$270.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.75 / $29.18 / $86.44	Professional	26	$17.75	$29.18	$86.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $62.26 / $184.44	Professional	TC	$38.76	$62.26	$184.44