Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $210.77 / $701.22 / $851.87	Facility		$210.77	$701.22	$851.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.01 / $44.06 / $56.05	Facility	26	$29.01	$44.06	$56.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $149.13 / $593.00	Professional		$113.82	$149.13	$593.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.44 / $26.64 / $111.00	Professional	26	$18.44	$26.64	$111.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $119.55 / $279.23	Professional	TC	$95.53	$119.55	$279.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $132.16 / $301.52 / $367.38	Facility		$132.16	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.44 / $313.39 / $466.56	Professional		$182.44	$313.39	$466.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.92 / $46.57 / $70.38	Professional	26	$25.92	$46.57	$70.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.29 / $267.38 / $411.69	Professional	TC	$157.29	$267.38	$411.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $271.27 / $316.14 / $387.47	Professional		$271.27	$316.14	$387.47
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.66 / $49.53 / $56.88	Professional	26	$41.66	$49.53	$56.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $228.78 / $267.68 / $330.58	Professional	TC	$228.78	$267.68	$330.58
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $125.75 / $245.04 / $447.02	Facility		$125.75	$245.04	$447.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $226.83 / $279.04 / $435.12	Professional		$226.83	$279.04	$435.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.76 / $43.77 / $71.08	Professional	26	$35.76	$43.77	$71.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.07 / $252.68 / $379.82	Professional	TC	$191.07	$252.68	$379.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.71 / $279.62 / $298.52	Facility		$204.71	$279.62	$298.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.43 / $43.81 / $46.23	Facility	26	$33.43	$43.81	$46.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $27.44 / $38.15 / $50.72	Professional	26	$27.44	$38.15	$50.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $145.52 / $207.50 / $276.79	Professional	TC	$145.52	$207.50	$276.79
Providence Facility/Professional Facility Modifier Low / Median / High Price $132.04 / $302.25 / $438.98	Facility		$132.04	$302.25	$438.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $262.02 / $323.98 / $420.98	Professional		$262.02	$323.98	$420.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.30 / $48.11 / $65.81	Professional	26	$27.30	$48.11	$65.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $170.07 / $274.02 / $357.95	Professional	TC	$170.07	$274.02	$357.95
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $291.56 / $385.75 / $463.05	Facility		$291.56	$385.75	$463.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $258.58 / $340.46 / $406.62	Professional		$258.58	$340.46	$406.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.43 / $53.07 / $63.72	Professional	26	$42.43	$53.07	$63.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $216.70 / $286.87 / $342.05	Professional	TC	$216.70	$286.87	$342.05
United Facility/Professional Professional Modifier Low / Median / High Price $172.23 / $288.32 / $439.16	Professional		$172.23	$288.32	$439.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.43 / $46.92 / $71.20	Professional	26	$25.43	$46.92	$71.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.37 / $245.66 / $367.70	Professional	TC	$154.37	$245.66	$367.70