Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $172.65 / $381.25	Facility	26	$105.78	$172.65	$381.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.93 / $380.45 / $1,378.73	Professional		$199.93	$380.45	$1,378.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.42 / $86.00 / $221.38	Professional	26	$63.42	$86.00	$221.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $133.19 / $285.00 / $487.26	Professional	TC	$133.19	$285.00	$487.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $243.43 / $435.03 / $673.59	Professional		$243.43	$435.03	$673.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.80 / $136.83 / $211.74	Professional	26	$71.80	$136.83	$211.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.41 / $296.39 / $478.58	Professional	TC	$166.41	$296.39	$478.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $443.39 / $501.14 / $607.08	Professional		$443.39	$501.14	$607.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $145.41 / $167.81 / $195.58	Professional	26	$145.41	$167.81	$195.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $293.51 / $333.33 / $411.51	Professional	TC	$293.51	$333.33	$411.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $369.53 / $473.87 / $704.22	Professional		$369.53	$473.87	$704.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $121.16 / $146.15 / $231.78	Professional	26	$121.16	$146.15	$231.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $237.50 / $338.26 / $472.12	Professional	TC	$237.50	$338.26	$472.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $101.43 / $140.76 / $154.77	Facility	26	$101.43	$140.76	$154.77
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $155.88 / $178.77	Professional		$140.29	$155.88	$178.77
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $91.66 / $122.96 / $160.24	Professional	26	$91.66	$122.96	$160.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $233.16 / $353.58 / $517.94	Professional	TC	$233.16	$353.58	$517.94
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $367.68 / $531.59 / $671.31	Professional		$367.68	$531.59	$671.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $78.68 / $138.27 / $222.24	Professional	26	$78.68	$138.27	$222.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.41 / $293.81 / $497.23	Professional	TC	$166.41	$293.81	$497.23
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 $412.97 / $540.36 / $653.78	Professional		$412.97	$540.36	$653.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $126.27 / $162.72 / $216.03	Professional	26	$126.27	$162.72	$216.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $276.51 / $364.02 / $460.64	Professional	TC	$276.51	$364.02	$460.64
United Facility/Professional Professional Modifier Low / Median / High Price $211.36 / $338.20 / $714.83	Professional		$211.36	$338.20	$714.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.15 / $90.28 / $236.20	Professional	26	$63.15	$90.28	$236.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.50 / $237.08 / $491.52	Professional	TC	$140.50	$237.08	$491.52