Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.23 / $879.80 / $899.89	Facility		$117.23	$879.80	$899.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $145.11 / $322.95	Professional		$113.82	$145.11	$322.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $23.79 / $54.71	Professional	26	$11.77	$23.79	$54.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.33 / $119.55 / $266.95	Professional	TC	$97.33	$119.55	$266.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $229.61 / $229.61 / $367.38	Facility		$229.61	$229.61	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.05 / $304.51 / $422.90	Professional		$179.05	$304.51	$422.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.12 / $42.33 / $58.34	Professional	26	$22.12	$42.33	$58.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $152.13 / $261.14 / $365.82	Professional	TC	$152.13	$261.14	$365.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.81 / $306.14 / $369.99	Professional		$239.81	$306.14	$369.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $46.71 / $56.78	Professional	26	$40.11	$46.71	$56.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.35 / $259.20 / $337.98	Professional	TC	$221.35	$259.20	$337.98
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $129.26 / $205.63 / $429.70	Facility		$129.26	$205.63	$429.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $231.63 / $285.82 / $387.96	Professional		$231.63	$285.82	$387.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.40 / $41.80 / $70.14	Professional	26	$23.40	$41.80	$70.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $195.34 / $252.17 / $376.14	Professional	TC	$195.34	$252.17	$376.14
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $211.52 / $284.88 / $351.69	Facility		$211.52	$284.88	$351.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $24.12 / $43.78 / $47.57	Facility	26	$24.12	$43.78	$47.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $17.59 / $28.14 / $51.10	Professional	26	$17.59	$28.14	$51.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $153.16 / $253.50 / $337.56	Professional	TC	$153.16	$253.50	$337.56
Providence Facility/Professional Facility Modifier Low / Median / High Price $130.84 / $227.43 / $428.00	Facility		$130.84	$227.43	$428.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $253.23 / $320.47 / $404.79	Professional		$253.23	$320.47	$404.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $44.18 / $60.63	Professional	26	$22.54	$44.18	$60.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $161.88 / $268.82 / $362.27	Professional	TC	$161.88	$268.82	$362.27
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $325.24 / $382.63 / $448.03	Facility		$325.24	$382.63	$448.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $277.67 / $331.00 / $415.95	Professional		$277.67	$331.00	$415.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $34.33 / $51.09 / $65.38	Professional	26	$34.33	$51.09	$65.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $233.84 / $279.00 / $352.91	Professional	TC	$233.84	$279.00	$352.91
United Facility/Professional Professional Modifier Low / Median / High Price $201.94 / $302.89 / $435.26	Professional		$201.94	$302.89	$435.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $46.14 / $72.72	Professional	26	$22.33	$46.14	$72.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.28 / $265.88 / $393.63	Professional	TC	$169.28	$265.88	$393.63