Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.79 / $275.12 / $613.71	Professional		$158.79	$275.12	$613.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.84 / $118.20 / $242.43	Professional	26	$92.84	$118.20	$242.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $116.58 / $204.12	Professional	TC	$65.95	$116.58	$204.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.16 / $232.31 / $399.56	Professional		$116.16	$232.31	$399.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.09 / $131.66 / $214.23	Professional	26	$69.09	$131.66	$214.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.07 / $100.64 / $204.87	Professional	TC	$47.07	$100.64	$204.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $226.41 / $468.97 / $668.45	Professional		$226.41	$468.97	$668.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.74 / $235.59 / $335.81	Professional	26	$113.74	$235.59	$335.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $112.67 / $233.38 / $332.65	Professional	TC	$112.67	$233.38	$332.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $347.70 / $414.51 / $751.15	Professional		$347.70	$414.51	$751.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $188.40 / $251.37 / $374.51	Professional	26	$188.40	$251.37	$374.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $171.10 / $249.24 / $376.64	Professional	TC	$171.10	$249.24	$376.64
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $149.13 / $235.60 / $253.64	Facility	26	$149.13	$235.60	$253.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $163.21 / $193.00 / $311.83	Professional	26	$163.21	$193.00	$311.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $113.97 / $167.11 / $290.08	Professional	TC	$113.97	$167.11	$290.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $232.31 / $468.00 / $684.00	Professional		$232.31	$468.00	$684.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.09 / $131.66 / $228.07	Professional	26	$69.09	$131.66	$228.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.07 / $100.64 / $225.50	Professional	TC	$47.07	$100.64	$225.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $415.36 / $476.51 / $754.01	Professional		$415.36	$476.51	$754.01
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $214.86 / $254.27 / $382.62	Professional	26	$214.86	$254.27	$382.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $200.50 / $222.23 / $374.87	Professional	TC	$200.50	$222.23	$374.87
United Facility/Professional Professional Modifier Low / Median / High Price $144.21 / $144.22 / $731.49	Professional		$144.21	$144.22	$731.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $133.88 / $378.41	Professional	26	$73.73	$133.88	$378.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.88 / $70.09 / $262.22	Professional	TC	$63.88	$70.09	$262.22