Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.49 / $374.50 / $561.75	Facility		$151.49	$374.50	$561.75
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $187.25 / $187.25 / $187.25	Facility	TC	$187.25	$187.25	$187.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.03 / $87.07 / $176.96	Professional		$64.03	$87.07	$176.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.73 / $37.83 / $99.57	Professional	26	$28.73	$37.83	$99.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.27 / $57.67 / $115.34	Professional	TC	$35.27	$57.67	$115.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $124.05 / $124.05 / $124.05	Facility		$124.05	$124.05	$124.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.95 / $116.22 / $169.57	Professional		$42.95	$116.22	$169.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.52 / $38.15 / $58.89	Professional	26	$20.52	$38.15	$58.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.43 / $78.06 / $111.35	Professional	TC	$22.43	$78.06	$111.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.58 / $222.83 / $317.62	Professional		$107.58	$222.83	$317.62
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.42 / $67.15 / $95.72	Professional	26	$32.42	$67.15	$95.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.16 / $155.68 / $221.90	Professional	TC	$75.16	$155.68	$221.90
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $70.39 / $115.15 / $251.71	Facility		$70.39	$115.15	$251.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.00 / $179.87 / $357.55	Professional		$104.00	$179.87	$357.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.91 / $76.05 / $107.16	Professional	26	$53.91	$76.05	$107.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.43 / $125.96 / $250.40	Professional	TC	$86.43	$125.96	$250.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $121.40 / $198.99 / $213.06	Facility		$121.40	$198.99	$213.06
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.39 / $67.15 / $71.70	Facility	26	$50.39	$67.15	$71.70
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $78.39 / $130.65 / $145.38	Facility	TC	$78.39	$130.65	$145.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.78 / $60.90 / $82.95	Professional	26	$48.78	$60.90	$82.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $89.63 / $117.59 / $157.91	Professional	TC	$89.63	$117.59	$157.91
Providence Facility/Professional Facility Modifier Low / Median / High Price $89.14 / $241.51 / $308.45	Facility		$89.14	$241.51	$308.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $116.22 / $196.02 / $292.04	Professional		$116.22	$196.02	$292.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.61 / $38.15 / $64.89	Professional	26	$20.61	$38.15	$64.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.94 / $78.06 / $127.26	Professional	TC	$31.94	$78.06	$127.26
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 $178.35 / $207.24 / $339.62	Professional		$178.35	$207.24	$339.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.45 / $68.84 / $107.87	Professional	26	$60.45	$68.84	$107.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $117.90 / $138.38 / $226.98	Professional	TC	$117.90	$138.38	$226.98
United Facility/Professional Professional Modifier Low / Median / High Price $63.51 / $64.31 / $314.08	Professional		$63.51	$64.31	$314.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $55.22 / $106.47	Professional	26	$22.09	$55.22	$106.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.22 / $105.57 / $207.61	Professional	TC	$42.22	$105.57	$207.61