Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $537.03 / $1,096.48	Facility		$169.82	$537.03	$1,096.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $123.03 / $354.81	Professional		$85.11	$123.03	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $87.10 / $354.81	Professional	26	$33.88	$87.10	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $74.13 / $158.49	Professional	TC	$46.77	$74.13	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $107.15 / $204.17	Professional		$52.48	$107.15	$204.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.88 / $70.79	Professional	26	$25.70	$33.88	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $72.44 / $123.03	Professional	TC	$29.51	$72.44	$123.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $239.88 / $346.74	Professional		$120.23	$239.88	$346.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $77.62 / $112.20	Professional	26	$38.90	$77.62	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $162.18 / $234.42	Professional	TC	$81.28	$162.18	$234.42
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $181.97 / $660.69	Facility		$104.71	$181.97	$660.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $213.80 / $389.05	Professional		$120.23	$213.80	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $89.13 / $162.18	Professional	26	$44.67	$89.13	$162.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $134.90 / $257.04	Professional	TC	$74.13	$134.90	$257.04
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $234.42 / $263.03	Facility		$194.98	$234.42	$263.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $79.43 / $102.33	Facility	26	$66.07	$79.43	$102.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $104.71	Professional	26	$56.23	$77.62	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $165.96	Professional	TC	$85.11	$117.49	$165.96
Providence Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $162.18 / $302.00	Facility		$104.71	$162.18	$302.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $234.42 / $363.08	Professional		$102.33	$234.42	$363.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $43.65 / $117.49	Professional	26	$31.62	$43.65	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $85.11 / $234.42	Professional	TC	$45.71	$85.11	$234.42
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 $144.54 / $239.88 / $371.54	Professional		$144.54	$239.88	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $81.28 / $128.82	Professional	26	$47.86	$81.28	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $158.49 / $245.47	Professional	TC	$95.50	$158.49	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $371.54	Professional		$75.86	$125.89	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $42.66 / $128.82	Professional	26	$26.30	$42.66	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $81.28 / $245.47	Professional	TC	$47.86	$81.28	$245.47