Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $186.21 / $223.87	Facility	26	$138.04	$186.21	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $741.31	Professional		$245.47	$371.54	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $91.20 / $204.17	Professional	26	$70.79	$91.20	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $501.19	Professional	TC	$169.82	$257.04	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $549.54 / $1,047.13	Professional		$309.03	$549.54	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $123.03 / $251.19	Professional	26	$79.43	$123.03	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $416.87 / $776.25	Professional	TC	$234.42	$416.87	$776.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $676.08 / $831.76	Professional		$588.84	$676.08	$831.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $177.83 / $218.78	Professional	26	$154.88	$177.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $501.19 / $616.60	Professional	TC	$426.58	$501.19	$616.60
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $173.78 / $223.87	Facility	26	$169.82	$173.78	$223.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $660.69 / $933.25	Professional		$467.74	$660.69	$933.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $251.19	Professional	26	$120.23	$169.82	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $478.63 / $741.31	Professional	TC	$363.08	$478.63	$741.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $173.78	Facility	26	$138.04	$165.96	$173.78
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $380.19 / $380.19	Professional		$239.88	$380.19	$380.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $154.88 / $190.55	Professional	26	$102.33	$154.88	$190.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $436.52 / $630.96	Professional	TC	$281.84	$436.52	$630.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $676.08 / $954.99	Professional		$346.74	$676.08	$954.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $173.78 / $251.19	Professional	26	$83.18	$173.78	$251.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $478.63 / $776.25	Professional	TC	$239.88	$478.63	$776.25
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.14 / $851.14 / $851.14	Facility	26	$851.14	$851.14	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $676.08 / $851.14	Professional		$549.54	$676.08	$851.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $177.83 / $229.09	Professional	26	$151.36	$177.83	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $489.78 / $660.69	Professional	TC	$407.38	$489.78	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $933.25	Professional		$275.42	$478.63	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $245.47	Professional	26	$77.62	$109.65	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $380.19 / $707.95	Professional	TC	$199.53	$380.19	$707.95