Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $305.23 / $674.10 / $1,209.36	Facility		$305.23	$674.10	$1,209.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.89 / $62.29 / $83.05	Facility	26	$58.89	$62.29	$83.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.40 / $212.66 / $859.00	Professional		$182.40	$212.66	$859.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.82 / $40.81 / $97.24	Professional	26	$30.82	$40.81	$97.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $150.79 / $172.36 / $378.62	Professional	TC	$150.79	$172.36	$378.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $156.80 / $636.79 / $835.09	Facility		$156.80	$636.79	$835.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $231.19 / $406.79 / $581.76	Professional		$231.19	$406.79	$581.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.18 / $77.14 / $115.39	Professional	26	$42.18	$77.14	$115.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.68 / $326.14 / $485.43	Professional	TC	$190.68	$326.14	$485.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $342.20 / $398.79 / $487.08	Professional		$342.20	$398.79	$487.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $69.83 / $82.88 / $95.36	Professional	26	$69.83	$82.88	$95.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $271.08 / $317.16 / $391.70	Professional	TC	$271.08	$317.16	$391.70
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $187.61 / $345.01 / $533.54	Facility		$187.61	$345.01	$533.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $288.52 / $355.47 / $549.99	Professional		$288.52	$355.47	$549.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.85 / $72.42 / $120.97	Professional	26	$60.85	$72.42	$120.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $226.30 / $297.80 / $449.85	Professional	TC	$226.30	$297.80	$449.85
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $267.54 / $352.72 / $424.11	Facility		$267.54	$352.72	$424.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.75 / $70.69 / $75.70	Facility	26	$54.75	$70.69	$75.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $41.95 / $56.78 / $79.66	Professional	26	$41.95	$56.78	$79.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $176.88 / $279.41 / $357.86	Professional	TC	$176.88	$279.41	$357.86
Providence Facility/Professional Facility Modifier Low / Median / High Price $187.61 / $406.52 / $533.54	Facility		$187.61	$406.52	$533.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $334.96 / $420.90 / $529.50	Professional		$334.96	$420.90	$529.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.29 / $78.42 / $106.65	Professional	26	$45.29	$78.42	$106.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $201.62 / $336.61 / $456.47	Professional	TC	$201.62	$336.61	$456.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $637.02 / $797.96 / $962.78	Facility		$637.02	$797.96	$962.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $342.55 / $428.66 / $512.60	Professional		$342.55	$428.66	$512.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $59.80 / $87.42 / $106.12	Professional	26	$59.80	$87.42	$106.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $271.63 / $351.65 / $406.48	Professional	TC	$271.63	$351.65	$406.48
United Facility/Professional Professional Modifier Low / Median / High Price $226.76 / $390.42 / $560.48	Professional		$226.76	$390.42	$560.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.68 / $73.92 / $118.04	Professional	26	$43.68	$73.92	$118.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.08 / $309.89 / $452.17	Professional	TC	$187.08	$309.89	$452.17