Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $172.69 / $348.78	Facility	26	$127.92	$172.69	$348.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $279.29 / $494.18 / $1,719.73	Professional		$279.29	$494.18	$1,719.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.02 / $118.59 / $191.25	Professional	26	$70.02	$118.59	$191.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $209.27 / $348.53 / $585.67	Professional	TC	$209.27	$348.53	$585.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $293.42 / $574.75 / $886.45	Professional		$293.42	$574.75	$886.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.61 / $125.08 / $203.56	Professional	26	$68.61	$125.08	$203.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $222.96 / $441.21 / $683.31	Professional	TC	$222.96	$441.21	$683.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $525.60 / $608.84 / $723.58	Professional		$525.60	$608.84	$723.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $132.44 / $153.16 / $178.13	Professional	26	$132.44	$153.16	$178.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $389.08 / $455.68 / $545.47	Professional	TC	$389.08	$455.68	$545.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $425.37 / $549.27 / $845.58	Professional		$425.37	$549.27	$845.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $110.48 / $137.35 / $211.47	Professional	26	$110.48	$137.35	$211.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $314.89 / $448.47 / $730.98	Professional	TC	$314.89	$448.47	$730.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $102.90 / $136.53 / $140.69	Facility	26	$102.90	$136.53	$140.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $178.16 / $178.16 / $178.16	Professional		$178.16	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.42 / $126.66 / $163.02	Professional	26	$84.42	$126.66	$163.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $297.61 / $443.49 / $595.96	Professional	TC	$297.61	$443.49	$595.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $446.25 / $650.30 / $816.74	Professional		$446.25	$650.30	$816.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.80 / $125.39 / $203.56	Professional	26	$71.80	$125.39	$203.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $222.96 / $441.21 / $683.31	Professional	TC	$222.96	$441.21	$683.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $497.35 / $648.66 / $797.15	Professional		$497.35	$648.66	$797.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $124.49 / $147.87 / $197.08	Professional	26	$124.49	$147.87	$197.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $372.87 / $489.30 / $620.54	Professional	TC	$372.87	$489.30	$620.54
United Facility/Professional Professional Modifier Low / Median / High Price $266.27 / $520.79 / $883.44	Professional		$266.27	$520.79	$883.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.84 / $82.69 / $217.06	Professional	26	$63.84	$82.69	$217.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.85 / $308.70 / $673.79	Professional	TC	$201.85	$308.70	$673.79