Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.20 / $173.31 / $397.50	Facility	26	$103.20	$173.31	$397.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.76 / $438.87 / $1,362.45	Professional		$275.76	$438.87	$1,362.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.65 / $98.53 / $381.17	Professional	26	$82.65	$98.53	$381.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $350.77 / $614.20	Professional	TC	$171.62	$350.77	$614.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $310.70 / $559.92 / $858.00	Professional		$310.70	$559.92	$858.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.05 / $155.03 / $250.76	Professional	26	$85.05	$155.03	$250.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.92 / $398.43 / $661.81	Professional	TC	$223.92	$398.43	$661.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $566.20 / $633.74 / $777.40	Professional		$566.20	$633.74	$777.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $164.14 / $188.94 / $220.81	Professional	26	$164.14	$188.94	$220.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $397.01 / $450.68 / $556.59	Professional	TC	$397.01	$450.68	$556.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $472.36 / $597.00 / $911.38	Professional		$472.36	$597.00	$911.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.16 / $177.02 / $261.27	Professional	26	$137.16	$177.02	$261.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $321.30 / $457.62 / $638.71	Professional	TC	$321.30	$457.62	$638.71
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $126.91 / $169.19 / $178.82	Facility	26	$126.91	$169.19	$178.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.30 / $117.30 / $117.30	Professional		$117.30	$117.30	$117.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.20 / $164.14 / $193.05	Professional	26	$109.20	$164.14	$193.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $249.24 / $411.60 / $650.17	Professional	TC	$249.24	$411.60	$650.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $455.52 / $656.25 / $851.35	Professional		$455.52	$656.25	$851.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.59 / $155.03 / $250.76	Professional	26	$88.59	$155.03	$250.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $223.92 / $397.02 / $618.78	Professional	TC	$223.92	$397.02	$618.78
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 $523.69 / $673.92 / $828.31	Professional		$523.69	$673.92	$828.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.81 / $183.24 / $243.51	Professional	26	$153.81	$183.24	$243.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $369.87 / $480.90 / $588.44	Professional	TC	$369.87	$480.90	$588.44
United Facility/Professional Professional Modifier Low / Median / High Price $258.69 / $411.25 / $906.49	Professional		$258.69	$411.25	$906.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.14 / $111.53 / $266.25	Professional	26	$79.14	$111.53	$266.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $182.52 / $297.56 / $657.48	Professional	TC	$182.52	$297.56	$657.48