Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.56 / $141.06 / $256.50	Facility	26	$90.56	$141.06	$256.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.06 / $330.78 / $1,007.83	Professional		$193.06	$330.78	$1,007.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.95 / $99.46 / $304.89	Professional	26	$62.95	$99.46	$304.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $255.09 / $697.97	Professional	TC	$119.70	$255.09	$697.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.80 / $360.74 / $561.66	Professional		$202.80	$360.74	$561.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.39 / $117.87 / $189.54	Professional	26	$64.39	$117.87	$189.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.66 / $243.68 / $388.91	Professional	TC	$136.66	$243.68	$388.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $369.40 / $416.89 / $505.52	Professional		$369.40	$416.89	$505.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $124.25 / $143.72 / $167.17	Professional	26	$124.25	$143.72	$167.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $241.33 / $273.94 / $338.32	Professional	TC	$241.33	$273.94	$338.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $298.88 / $385.50 / $583.53	Professional		$298.88	$385.50	$583.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.54 / $129.31 / $199.26	Professional	26	$103.54	$129.31	$199.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $195.34 / $278.22 / $388.32	Professional	TC	$195.34	$278.22	$388.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.02 / $128.08 / $132.66	Facility	26	$97.02	$128.08	$132.66
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $231.04 / $231.04 / $231.04	Professional		$231.04	$231.04	$231.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.59 / $117.16 / $137.43	Professional	26	$79.59	$117.16	$137.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $187.73 / $257.77 / $413.54	Professional	TC	$187.73	$257.77	$413.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $304.81 / $442.70 / $559.48	Professional		$304.81	$442.70	$559.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.48 / $118.21 / $190.78	Professional	26	$67.48	$118.21	$190.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $136.66 / $240.36 / $400.25	Professional	TC	$136.66	$240.36	$400.25
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 $343.54 / $448.46 / $543.86	Professional		$343.54	$448.46	$543.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.31 / $139.38 / $185.71	Professional	26	$117.31	$139.38	$185.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $226.23 / $299.07 / $370.85	Professional	TC	$226.23	$299.07	$370.85
United Facility/Professional Professional Modifier Low / Median / High Price $174.85 / $267.42 / $596.89	Professional		$174.85	$267.42	$596.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.13 / $86.82 / $202.29	Professional	26	$60.13	$86.82	$202.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $194.47 / $403.31	Professional	TC	$114.72	$194.47	$403.31