Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.07 / $130.69 / $289.72	Facility	26	$116.07	$130.69	$289.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $316.27 / $1,110.28	Professional		$171.00	$316.27	$1,110.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $79.83 / $290.00	Professional	26	$52.78	$79.83	$290.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $116.84 / $260.23 / $377.54	Professional	TC	$116.84	$260.23	$377.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.13 / $398.65 / $578.22	Professional		$187.13	$398.65	$578.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.95 / $103.04 / $169.13	Professional	26	$55.95	$103.04	$169.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.97 / $292.69 / $406.00	Professional	TC	$129.97	$292.69	$406.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $341.50 / $383.14 / $467.82	Professional		$341.50	$383.14	$467.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $110.00 / $127.24 / $148.01	Professional	26	$110.00	$127.24	$148.01
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $228.11 / $258.95 / $319.81	Professional	TC	$228.11	$258.95	$319.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $284.83 / $388.80 / $549.55	Professional		$284.83	$388.80	$549.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.81 / $112.39 / $175.86	Professional	26	$91.81	$112.39	$175.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.67 / $263.01 / $461.28	Professional	TC	$184.67	$263.01	$461.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.26 / $113.39 / $117.25	Facility	26	$85.26	$113.39	$117.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $214.94 / $231.04	Professional		$155.88	$214.94	$231.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.00 / $103.80 / $121.56	Professional	26	$81.00	$103.80	$121.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $211.50 / $285.57 / $428.62	Professional	TC	$211.50	$285.57	$428.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $301.60 / $423.20 / $540.00	Professional		$301.60	$423.20	$540.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.53 / $104.11 / $169.14	Professional	26	$58.53	$104.11	$169.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $129.97 / $292.10 / $421.07	Professional	TC	$129.97	$292.10	$421.07
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 $316.01 / $426.16 / $525.21	Professional		$316.01	$426.16	$525.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.54 / $123.11 / $163.92	Professional	26	$103.54	$123.11	$163.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $212.47 / $288.00 / $376.38	Professional	TC	$212.47	$288.00	$376.38
United Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $259.92 / $571.74	Professional		$169.95	$259.92	$571.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.84 / $65.56 / $178.83	Professional	26	$52.84	$65.56	$178.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $196.22 / $393.19	Professional	TC	$116.88	$196.22	$393.19