Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $158.78 / $210.45 / $279.81	Facility		$158.78	$210.45	$279.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.70 / $134.71 / $207.40	Professional		$103.70	$134.71	$207.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.37 / $69.27 / $137.26	Professional	26	$53.37	$69.27	$137.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.73 / $76.88 / $151.44	Professional	TC	$71.73	$76.88	$151.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $164.00 / $164.00 / $164.00	Facility		$164.00	$164.00	$164.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.48 / $163.88 / $251.24	Professional		$64.48	$163.88	$251.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $76.43 / $116.87	Professional	26	$33.72	$76.43	$116.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.89 / $87.45 / $153.63	Professional	TC	$28.89	$87.45	$153.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $163.90 / $339.49 / $483.90	Professional		$163.90	$339.49	$483.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $64.83 / $134.28 / $191.40	Professional	26	$64.83	$134.28	$191.40
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.06 / $205.19 / $292.47	Professional	TC	$99.06	$205.19	$292.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $83.03 / $189.13 / $360.58	Facility		$83.03	$189.13	$360.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $207.27 / $274.33 / $545.33	Professional		$207.27	$274.33	$545.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.81 / $132.66 / $214.32	Professional	26	$107.81	$132.66	$214.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.50 / $166.52 / $331.02	Professional	TC	$110.50	$166.52	$331.02
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $165.66 / $277.72 / $336.34	Facility		$165.66	$277.72	$336.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.49 / $134.29 / $138.04	Facility	26	$98.49	$134.29	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.61 / $99.36 / $163.53	Professional	26	$81.61	$99.36	$163.53
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.25 / $108.96 / $180.81	Professional	TC	$91.25	$108.96	$180.81
Providence Facility/Professional Facility Modifier Low / Median / High Price $142.85 / $357.00 / $486.94	Facility		$142.85	$357.00	$486.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $163.88 / $307.83 / $460.99	Professional		$163.88	$307.83	$460.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $76.43 / $118.37	Professional	26	$40.81	$76.43	$118.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.85 / $87.45 / $175.57	Professional	TC	$44.85	$87.45	$175.57
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $203.33 / $203.33 / $204.49	Facility		$203.33	$203.33	$204.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $287.88 / $313.70 / $536.14	Professional		$287.88	$313.70	$536.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $121.50 / $139.07 / $216.36	Professional	26	$121.50	$139.07	$216.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $166.38 / $175.14 / $320.31	Professional	TC	$166.38	$175.14	$320.31
United Facility/Professional Professional Modifier Low / Median / High Price $94.41 / $236.03 / $533.91	Professional		$94.41	$236.03	$533.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.39 / $73.98 / $213.96	Professional	26	$44.39	$73.98	$213.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.02 / $83.37 / $293.02	Professional	TC	$50.02	$83.37	$293.02