Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $178.95 / $413.18	Facility	26	$105.78	$178.95	$413.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $249.27 / $431.45 / $1,199.43	Professional		$249.27	$431.45	$1,199.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.09 / $95.03 / $371.91	Professional	26	$72.09	$95.03	$371.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $351.12 / $612.94	Professional	TC	$171.62	$351.12	$612.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.82 / $549.48 / $941.89	Professional		$304.82	$549.48	$941.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.59 / $148.97 / $239.45	Professional	26	$81.59	$148.97	$239.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $220.88 / $396.89 / $707.90	Professional	TC	$220.88	$396.89	$707.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $555.36 / $620.50 / $762.89	Professional		$555.36	$620.50	$762.89
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $157.46 / $181.29 / $211.85	Professional	26	$157.46	$181.29	$211.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $393.03 / $446.18 / $551.03	Professional	TC	$393.03	$446.18	$551.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $449.39 / $640.04 / $950.04	Professional		$449.39	$640.04	$950.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.29 / $165.65 / $252.12	Professional	26	$131.29	$165.65	$252.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $318.10 / $453.06 / $695.52	Professional	TC	$318.10	$453.06	$695.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $122.01 / $162.32 / $167.50	Facility	26	$122.01	$162.32	$167.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $106.64 / $149.63 / $173.56	Professional	26	$106.64	$149.63	$173.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $277.44 / $410.38 / $924.60	Professional	TC	$277.44	$410.38	$924.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $447.12 / $663.64 / $871.47	Professional		$447.12	$663.64	$871.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.13 / $149.47 / $240.93	Professional	26	$85.13	$149.47	$240.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $220.88 / $390.28 / $707.90	Professional	TC	$220.88	$390.28	$707.90
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 $514.11 / $671.11 / $911.34	Professional		$514.11	$671.11	$911.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $148.43 / $176.17 / $234.98	Professional	26	$148.43	$176.17	$234.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $365.68 / $473.57 / $689.45	Professional	TC	$365.68	$473.57	$689.45
United Facility/Professional Professional Modifier Low / Median / High Price $252.90 / $468.69 / $889.92	Professional		$252.90	$468.69	$889.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.08 / $148.74 / $274.41	Professional	26	$76.08	$148.74	$274.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.07 / $379.90 / $650.04	Professional	TC	$180.07	$379.90	$650.04