Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $272.00 / $272.00 / $669.00	Facility		$272.00	$272.00	$669.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.56 / $157.97 / $301.68	Professional		$112.56	$157.97	$301.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.30 / $36.77 / $71.18	Professional	26	$29.30	$36.77	$71.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.64 / $106.36 / $296.42	Professional	TC	$70.64	$106.36	$296.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $212.88 / $212.88 / $212.88	Facility		$212.88	$212.88	$212.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.16 / $186.69 / $250.31	Professional		$58.16	$186.69	$250.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $41.84 / $61.30	Professional	26	$19.55	$41.84	$61.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.51 / $144.85 / $199.29	Professional	TC	$37.51	$144.85	$199.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.02 / $341.81 / $487.21	Professional		$165.02	$341.81	$487.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $35.96 / $74.48 / $106.17	Professional	26	$35.96	$74.48	$106.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $129.06 / $267.32 / $381.04	Professional	TC	$129.06	$267.32	$381.04
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $135.46 / $182.42 / $421.64	Facility		$135.46	$182.42	$421.64
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $249.17 / $302.69 / $548.51	Professional		$249.17	$302.69	$548.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.98 / $65.58 / $118.83	Professional	26	$53.98	$65.58	$118.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $195.19 / $237.11 / $429.68	Professional	TC	$195.19	$237.11	$429.68
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $214.19 / $326.29 / $347.73	Facility		$214.19	$326.29	$347.73
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.62 / $72.58 / $74.80	Facility	26	$44.62	$72.58	$74.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.84 / $61.05 / $90.06	Professional	26	$48.84	$61.05	$90.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $163.94 / $224.40 / $294.67	Professional	TC	$163.94	$224.40	$294.67
Providence Facility/Professional Facility Modifier Low / Median / High Price $182.42 / $407.95 / $503.43	Facility		$182.42	$407.95	$503.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.69 / $325.00 / $490.98	Professional		$186.69	$325.00	$490.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.63 / $41.84 / $64.09	Professional	26	$22.63	$41.84	$64.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $59.89 / $144.85 / $209.53	Professional	TC	$59.89	$144.85	$209.53
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,191.76 / $1,191.76 / $1,198.55	Facility		$1,191.76	$1,191.76	$1,198.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $299.85 / $348.35 / $554.29	Professional		$299.85	$348.35	$554.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.43 / $74.98 / $118.55	Professional	26	$66.43	$74.98	$118.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $233.42 / $273.36 / $435.74	Professional	TC	$233.42	$273.36	$435.74
United Facility/Professional Professional Modifier Low / Median / High Price $105.24 / $105.24 / $528.04	Professional		$105.24	$105.24	$528.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.04 / $39.49 / $116.98	Professional	26	$24.04	$39.49	$116.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.20 / $131.72 / $411.06	Professional	TC	$81.20	$131.72	$411.06