Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $119.58 / $261.25	Facility	26	$86.00	$119.58	$261.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.96 / $316.16 / $1,032.00	Professional		$145.96	$316.16	$1,032.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.00 / $77.83 / $224.00	Professional	26	$53.00	$77.83	$224.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.87 / $259.17 / $440.02	Professional	TC	$113.87	$259.17	$440.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.14 / $349.19 / $550.66	Professional		$184.14	$349.19	$550.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.46 / $105.93 / $161.27	Professional	26	$54.46	$105.93	$161.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.22 / $243.64 / $402.26	Professional	TC	$128.22	$243.64	$402.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $335.08 / $374.88 / $459.36	Professional		$335.08	$374.88	$459.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $105.06 / $120.93 / $141.38	Professional	26	$105.06	$120.93	$141.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $226.79 / $257.44 / $317.94	Professional	TC	$226.79	$257.44	$317.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $271.13 / $376.50 / $541.79	Professional		$271.13	$376.50	$541.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.53 / $112.86 / $167.73	Professional	26	$87.53	$112.86	$167.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.60 / $261.48 / $461.28	Professional	TC	$183.60	$261.48	$461.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.22 / $108.28 / $119.26	Facility	26	$87.22	$108.28	$119.26
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $101.46 / $122.82	Professional	26	$70.80	$101.46	$122.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $151.60 / $262.50 / $434.24	Professional	TC	$151.60	$262.50	$434.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $278.77 / $412.80 / $519.79	Professional		$278.77	$412.80	$519.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.41 / $105.93 / $161.27	Professional	26	$56.41	$105.93	$161.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $241.00 / $396.23	Professional	TC	$129.22	$241.00	$396.23
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 $310.02 / $415.00 / $524.60	Professional		$310.02	$415.00	$524.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $98.75 / $120.05 / $156.34	Professional	26	$98.75	$120.05	$156.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $211.27 / $284.16 / $372.69	Professional	TC	$211.27	$284.16	$372.69
United Facility/Professional Professional Modifier Low / Median / High Price $169.33 / $266.26 / $570.53	Professional		$169.33	$266.26	$570.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.06 / $76.87 / $180.01	Professional	26	$54.06	$76.87	$180.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.03 / $213.06 / $387.58	Professional	TC	$115.03	$213.06	$387.58