Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.07 / $142.83 / $288.58	Facility	26	$116.07	$142.83	$288.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $167.60 / $315.56 / $1,104.16	Professional		$167.60	$315.56	$1,104.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $74.25 / $290.00	Professional	26	$52.78	$74.25	$290.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.87 / $259.52 / $376.52	Professional	TC	$113.87	$259.52	$376.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.16 / $396.80 / $575.25	Professional		$186.16	$396.80	$575.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.79 / $104.11 / $167.03	Professional	26	$56.79	$104.11	$167.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $292.27 / $406.00	Professional	TC	$129.22	$292.27	$406.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $339.76 / $380.26 / $465.38	Professional		$339.76	$380.26	$465.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.60 / $126.52 / $147.44	Professional	26	$109.60	$126.52	$147.44
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 $274.86 / $379.37 / $546.38	Professional		$274.86	$379.37	$546.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.26 / $113.90 / $174.87	Professional	26	$91.26	$113.90	$174.87
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 $85.26 / $112.96 / $116.58	Facility	26	$85.26	$112.96	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $226.71 / $226.71 / $226.71	Professional		$226.71	$226.71	$226.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $103.97 / $132.01	Professional	26	$69.95	$103.97	$132.01
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $188.94 / $267.89 / $381.24	Professional	TC	$188.94	$267.89	$381.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $299.97 / $421.58 / $536.90	Professional		$299.97	$421.58	$536.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.48 / $104.27 / $168.16	Professional	26	$59.48	$104.27	$168.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $290.25 / $418.66	Professional	TC	$129.22	$290.25	$418.66
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,538.06 / $1,538.06 / $1,538.06	Facility	26	$1,538.06	$1,538.06	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $314.20 / $423.78 / $523.99	Professional		$314.20	$423.78	$523.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.94 / $123.11 / $162.97	Professional	26	$102.94	$123.11	$162.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $211.27 / $286.35 / $375.15	Professional	TC	$211.27	$286.35	$375.15
United Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $265.73 / $569.51	Professional		$169.02	$265.73	$569.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.07 / $71.93 / $178.21	Professional	26	$53.07	$71.93	$178.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.95 / $187.69 / $390.59	Professional	TC	$115.95	$187.69	$390.59