Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.97 / $148.44 / $299.87	Facility	26	$129.97	$148.44	$299.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $371.00 / $1,087.48	Professional		$171.00	$371.00	$1,087.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.61 / $78.29 / $190.64	Professional	26	$53.61	$78.29	$190.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $285.00 / $518.85	Professional	TC	$119.70	$285.00	$518.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.13 / $381.20 / $627.67	Professional		$203.13	$381.20	$627.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.00 / $109.39 / $175.04	Professional	26	$59.00	$109.39	$175.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $142.55 / $269.45 / $466.75	Professional	TC	$142.55	$269.45	$466.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $369.30 / $417.88 / $506.35	Professional		$369.30	$417.88	$506.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.90 / $131.75 / $153.18	Professional	26	$113.90	$131.75	$153.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $251.89 / $286.13 / $353.14	Professional	TC	$251.89	$286.13	$353.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $307.94 / $425.68 / $617.52	Professional		$307.94	$425.68	$617.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.01 / $127.00 / $183.00	Professional	26	$95.01	$127.00	$183.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.87 / $290.37 / $461.28	Professional	TC	$203.87	$290.37	$461.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $88.69 / $117.40 / $131.00	Facility	26	$88.69	$117.40	$131.00
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $247.14 / $247.14 / $247.14	Professional		$247.14	$247.14	$247.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.20 / $115.14 / $135.75	Professional	26	$81.20	$115.14	$135.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $185.72 / $265.32 / $546.92	Professional	TC	$185.72	$265.32	$546.92
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $308.77 / $450.77 / $585.42	Professional		$308.77	$450.77	$585.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.95 / $110.33 / $175.04	Professional	26	$61.95	$110.33	$175.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $142.55 / $267.20 / $466.75	Professional	TC	$142.55	$267.20	$466.75
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $344.14 / $451.61 / $605.55	Professional		$344.14	$451.61	$605.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $128.06 / $170.55	Professional	26	$107.73	$128.06	$170.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $236.41 / $310.23 / $445.72	Professional	TC	$236.41	$310.23	$445.72
United Facility/Professional Professional Modifier Low / Median / High Price $175.77 / $276.35 / $592.24	Professional		$175.77	$276.35	$592.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $80.92 / $185.76	Professional	26	$55.22	$80.92	$185.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.55 / $241.86 / $420.23	Professional	TC	$120.55	$241.86	$420.23