Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $158.49 / $263.03	Facility	26	$112.20	$158.49	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $478.63 / $1,230.27	Professional		$295.12	$478.63	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $125.89 / $194.98	Professional	26	$72.44	$125.89	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $338.84 / $575.44	Professional	TC	$213.80	$338.84	$575.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $524.81 / $954.99	Professional		$281.84	$524.81	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $100.00 / $208.93	Professional	26	$64.57	$100.00	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $398.11 / $794.33	Professional	TC	$208.93	$398.11	$794.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $575.44 / $724.44	Professional		$501.19	$575.44	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $147.91 / $177.83	Professional	26	$125.89	$147.91	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $436.52 / $549.54	Professional	TC	$371.54	$436.52	$549.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $263.03 / $263.03	Facility	26	$128.82	$263.03	$263.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $602.56 / $851.14	Professional		$436.52	$602.56	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $141.25 / $204.17	Professional	26	$109.65	$141.25	$204.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $446.68 / $691.83	Professional	TC	$323.59	$446.68	$691.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $138.04 / $141.25	Facility	26	$114.82	$138.04	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $123.03 / $151.36	Professional	26	$83.18	$123.03	$151.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $426.58 / $616.60	Professional	TC	$281.84	$426.58	$616.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $616.60 / $851.14	Professional		$302.00	$616.60	$851.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $141.25 / $204.17	Professional	26	$69.18	$141.25	$204.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $489.78 / $741.31	Professional	TC	$208.93	$489.78	$741.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $630.96 / $794.33	Professional		$501.19	$630.96	$794.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $147.91 / $190.55	Professional	26	$125.89	$147.91	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $478.63 / $616.60	Professional	TC	$371.54	$478.63	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $446.68 / $891.25	Professional		$269.15	$446.68	$891.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $87.10 / $199.53	Professional	26	$64.57	$87.10	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $389.05 / $676.08	Professional	TC	$204.17	$389.05	$676.08