Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $170.88 / $218.68 / $805.50	Facility		$170.88	$218.68	$805.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $121.56 / $242.06	Professional		$75.95	$121.56	$242.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.70 / $45.50 / $174.91	Professional	26	$31.70	$45.50	$174.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.21 / $73.48 / $100.42	Professional	TC	$50.21	$73.48	$100.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $124.58 / $124.58 / $124.58	Facility		$124.58	$124.58	$124.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.38 / $140.88 / $203.66	Professional		$52.38	$140.88	$203.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $47.79 / $70.45	Professional	26	$26.81	$47.79	$70.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $93.13 / $123.69	Professional	TC	$25.57	$93.13	$123.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.02 / $236.17 / $336.63	Professional		$114.02	$236.17	$336.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $79.84 / $113.82	Professional	26	$38.54	$79.84	$113.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $75.48 / $156.34 / $222.85	Professional	TC	$75.48	$156.34	$222.85
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $82.90 / $135.52 / $341.13	Facility		$82.90	$135.52	$341.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $172.07 / $209.02 / $378.77	Professional		$172.07	$209.02	$378.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.05 / $95.81 / $127.33	Professional	26	$64.05	$95.81	$127.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.90 / $126.49 / $251.44	Professional	TC	$102.90	$126.49	$251.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $170.61 / $236.18 / $265.32	Facility		$170.61	$236.18	$265.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $79.84 / $99.45	Facility	26	$65.98	$79.84	$99.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $77.94 / $112.00	Professional	26	$70.80	$77.94	$112.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $87.36 / $140.69 / $183.11	Professional	TC	$87.36	$140.69	$183.11
Providence Facility/Professional Facility Modifier Low / Median / High Price $124.58 / $286.74 / $350.17	Facility		$124.58	$286.74	$350.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $142.16 / $235.62 / $344.96	Professional		$142.16	$235.62	$344.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $47.79 / $77.09	Professional	26	$31.31	$47.79	$77.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.18 / $94.38 / $141.36	Professional	TC	$45.18	$94.38	$141.36
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 $210.67 / $244.05 / $385.55	Professional		$210.67	$244.05	$385.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.42 / $82.49 / $128.96	Professional	26	$72.42	$82.49	$128.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $138.25 / $161.56 / $257.39	Professional	TC	$138.25	$161.56	$257.39
United Facility/Professional Professional Modifier Low / Median / High Price $76.44 / $125.24 / $371.00	Professional		$76.44	$125.24	$371.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.97 / $26.42 / $91.91	Professional	26	$23.97	$26.42	$91.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.02 / $82.19 / $243.48	Professional	TC	$50.02	$82.19	$243.48