Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $262.38 / $661.94 / $1,223.83	Facility		$262.38	$661.94	$1,223.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.05 / $51.05 / $57.43	Facility	26	$51.05	$51.05	$57.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.75 / $130.57 / $536.00	Professional		$103.75	$130.57	$536.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.50 / $24.76 / $71.14	Professional	26	$20.50	$24.76	$71.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $106.95 / $237.10	Professional	TC	$95.53	$106.95	$237.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $103.54 / $301.52 / $367.38	Facility		$103.54	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.76 / $259.36 / $393.58	Professional		$151.76	$259.36	$393.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.61 / $47.62 / $72.23	Professional	26	$26.61	$47.62	$72.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.49 / $213.09 / $328.71	Professional	TC	$127.49	$213.09	$328.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $222.57 / $259.38 / $317.06	Professional		$222.57	$259.38	$317.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $42.76 / $50.77 / $58.39	Professional	26	$42.76	$50.77	$58.39
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $179.01 / $209.45 / $258.67	Professional	TC	$179.01	$209.45	$258.67
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $122.12 / $227.71 / $364.99	Facility		$122.12	$227.71	$364.99
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $186.27 / $245.82 / $356.82	Professional		$186.27	$245.82	$356.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.83 / $45.09 / $73.20	Professional	26	$36.83	$45.09	$73.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.44 / $197.44 / $297.07	Professional	TC	$149.44	$197.44	$297.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $167.58 / $229.42 / $293.45	Facility		$167.58	$229.42	$293.45
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.40 / $43.56 / $46.92	Facility	26	$34.40	$43.56	$46.92
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $36.21 / $52.47	Professional	26	$28.14	$36.21	$52.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $121.50 / $188.50 / $249.40	Professional	TC	$121.50	$188.50	$249.40
Providence Facility/Professional Facility Modifier Low / Median / High Price $122.12 / $263.89 / $364.99	Facility		$122.12	$263.89	$364.99
Providence Facility/Professional Professional Modifier Low / Median / High Price $215.46 / $275.69 / $351.13	Professional		$215.46	$275.69	$351.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $49.09 / $66.56	Professional	26	$29.65	$49.09	$66.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $129.60 / $218.60 / $317.94	Professional	TC	$129.60	$218.60	$317.94
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 $222.24 / $284.70 / $332.57	Professional		$222.24	$284.70	$332.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.65 / $54.64 / $65.30	Professional	26	$39.65	$54.64	$65.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $179.19 / $228.98 / $268.14	Professional	TC	$179.19	$228.98	$268.14
United Facility/Professional Facility Modifier Low / Median / High Price $110.74 / $110.74 / $110.74	Facility		$110.74	$110.74	$110.74
United Facility/Professional Professional Modifier Low / Median / High Price $140.79 / $239.41 / $363.62	Professional		$140.79	$239.41	$363.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.30 / $46.20 / $72.34	Professional	26	$27.30	$46.20	$72.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.40 / $193.76 / $293.18	Professional	TC	$121.40	$193.76	$293.18