Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $457.09 / $741.31	Facility		$151.36	$457.09	$741.31
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $269.15 / $269.15 / $338.84	Facility	TC	$269.15	$269.15	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $426.58	Professional		$63.10	$89.13	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $63.10 / $213.80	Professional	26	$26.92	$63.10	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $173.78	Professional	TC	$43.65	$64.57	$173.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $100.00 / $169.82	Professional		$48.98	$100.00	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $28.84 / $58.88	Professional	26	$18.62	$28.84	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $70.79 / $112.20	Professional	TC	$26.92	$70.79	$112.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $218.78 / $316.23	Professional		$109.65	$218.78	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $66.07 / $93.33	Professional	26	$32.36	$66.07	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $154.88 / $218.78	Professional	TC	$77.62	$154.88	$218.78
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $186.21 / $512.86	Facility		$85.11	$186.21	$512.86
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $269.15 / $269.15 / $338.84	Facility	TC	$269.15	$269.15	$338.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $181.97 / $331.13	Professional		$85.11	$181.97	$331.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $72.44 / $112.20	Professional	26	$34.67	$72.44	$112.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $114.82 / $177.83	Professional	TC	$57.54	$114.82	$177.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $199.53 / $213.80	Facility		$147.91	$199.53	$213.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $67.61 / $72.44	Facility	26	$54.95	$67.61	$72.44
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $95.50 / $131.83 / $144.54	Facility	TC	$95.50	$131.83	$144.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $81.28	Professional	26	$41.69	$58.88	$81.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $120.23 / $147.91	Professional	TC	$89.13	$120.23	$147.91
Providence Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $141.25 / $263.03	Facility		$85.11	$141.25	$263.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $190.55 / $316.23	Professional		$100.00	$190.55	$316.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $36.31 / $97.72	Professional	26	$20.42	$36.31	$97.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $75.86 / $229.09	Professional	TC	$33.88	$75.86	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $676.08	Facility		$645.65	$645.65	$676.08
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $199.53 / $316.23	Professional		$125.89	$199.53	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $67.61 / $107.15	Professional	26	$40.74	$67.61	$107.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $134.90 / $213.80	Professional	TC	$87.10	$134.90	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $107.15 / $316.23	Professional		$63.10	$107.15	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $37.15 / $107.15	Professional	26	$21.88	$37.15	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $70.79 / $208.93	Professional	TC	$42.66	$70.79	$208.93