Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $160.34 / $355.76	Facility	26	$127.92	$160.34	$355.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.60 / $475.00 / $1,552.73	Professional		$259.60	$475.00	$1,552.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.84 / $128.00 / $315.00	Professional	26	$69.84	$128.00	$315.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $338.49 / $504.89	Professional	TC	$187.50	$338.49	$504.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $272.66 / $622.69 / $900.00	Professional		$272.66	$622.69	$900.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.04 / $122.40 / $207.49	Professional	26	$65.04	$122.40	$207.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.79 / $475.19 / $756.98	Professional	TC	$200.79	$475.19	$756.98
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $494.57 / $557.82 / $679.91	Professional		$494.57	$557.82	$679.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $135.04 / $156.12 / $181.66	Professional	26	$135.04	$156.12	$181.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $355.38 / $403.42 / $498.22	Professional	TC	$355.38	$403.42	$498.22
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $412.42 / $599.63 / $927.99	Professional		$412.42	$599.63	$927.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.56 / $142.66 / $215.52	Professional	26	$109.56	$142.66	$215.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $287.68 / $409.72 / $733.95	Professional	TC	$287.68	$409.72	$733.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $86.16 / $126.63 / $142.71	Facility	26	$86.16	$126.63	$142.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.80 / $107.54 / $149.34	Professional	26	$68.80	$107.54	$149.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $339.95 / $525.46 / $845.46	Professional	TC	$339.95	$525.46	$845.46
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $437.38 / $630.79 / $892.17	Professional		$437.38	$630.79	$892.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.87 / $126.66 / $207.49	Professional	26	$71.87	$126.66	$207.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $203.41 / $471.21 / $756.98	Professional	TC	$203.41	$471.21	$756.98
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 $459.65 / $621.39 / $885.72	Professional		$459.65	$621.39	$885.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $105.78 / $151.41 / $200.87	Professional	26	$105.78	$151.41	$200.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $332.77 / $449.63 / $678.26	Professional	TC	$332.77	$449.63	$678.26
United Facility/Professional Professional Modifier Low / Median / High Price $237.43 / $439.78 / $817.06	Professional		$237.43	$439.78	$817.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.47 / $87.90 / $220.15	Professional	26	$52.47	$87.90	$220.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.09 / $337.50 / $604.97	Professional	TC	$172.09	$337.50	$604.97