Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $870.96 / $891.25	Facility		$117.49	$870.96	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $354.81	Professional		$102.33	$144.54	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $23.99 / $54.95	Professional	26	$12.88	$23.99	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $117.49 / $234.42	Professional	TC	$97.72	$117.49	$234.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $229.09 / $371.54	Facility		$229.09	$229.09	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $302.00 / $416.87	Professional		$177.83	$302.00	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $39.81 / $58.88	Professional	26	$19.95	$39.81	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $263.03 / $363.08	Professional	TC	$151.36	$263.03	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $309.03 / $371.54	Professional		$251.19	$309.03	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $56.23	Professional	26	$37.15	$46.77	$56.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $263.03 / $309.03	Professional	TC	$218.78	$263.03	$309.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $169.82 / $380.19	Facility		$117.49	$169.82	$380.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $288.40 / $380.19	Professional		$218.78	$288.40	$380.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $42.66 / $58.88	Professional	26	$22.91	$42.66	$58.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $257.04 / $323.59	Professional	TC	$141.25	$257.04	$323.59
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $281.84 / $346.74	Facility		$239.88	$281.84	$346.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $43.65 / $47.86	Facility	26	$23.99	$43.65	$47.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.84 / $51.29	Professional	26	$17.38	$28.84	$51.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $338.84	Professional	TC	$169.82	$257.04	$338.84
Providence Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $190.55 / $389.05	Facility		$125.89	$190.55	$389.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $331.13 / $407.38	Professional		$257.04	$331.13	$407.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $42.66 / $60.26	Professional	26	$22.91	$42.66	$60.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $275.42 / $363.08	Professional	TC	$181.97	$275.42	$363.08
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $446.68 / $457.09	Facility		$363.08	$446.68	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $331.13 / $398.11	Professional		$275.42	$331.13	$398.11
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $50.12 / $63.10	Professional	26	$38.90	$50.12	$63.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $281.84 / $346.74	Professional	TC	$234.42	$281.84	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $309.03 / $436.52	Professional		$194.98	$309.03	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $45.71 / $66.07	Professional	26	$21.88	$45.71	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $380.19	Professional	TC	$177.83	$263.03	$380.19