Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.52 / $191.29 / $422.48	Facility	26	$167.52	$191.29	$422.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $225.49 / $392.29 / $1,146.96	Professional		$225.49	$392.29	$1,146.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.23 / $86.92 / $232.07	Professional	26	$70.23	$86.92	$232.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.59 / $309.93 / $508.96	Professional	TC	$151.59	$309.93	$508.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.18 / $560.37 / $921.43	Professional		$331.18	$560.37	$921.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.65 / $153.03 / $246.83	Professional	26	$83.65	$153.03	$246.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $238.73 / $413.95 / $674.60	Professional	TC	$238.73	$413.95	$674.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $611.10 / $692.62 / $840.46	Professional		$611.10	$692.62	$840.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $161.56 / $185.98 / $217.18	Professional	26	$161.56	$185.98	$217.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $444.57 / $506.78 / $623.28	Professional	TC	$444.57	$506.78	$623.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $495.60 / $632.00 / $960.54	Professional		$495.60	$632.00	$960.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.04 / $170.18 / $257.19	Professional	26	$135.04	$170.18	$257.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $359.73 / $512.35 / $729.56	Professional	TC	$359.73	$512.35	$729.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $126.42 / $166.54 / $172.86	Facility	26	$126.42	$166.54	$172.86
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 $103.72 / $154.19 / $190.92	Professional	26	$103.72	$154.19	$190.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $255.07 / $444.28 / $625.24	Professional	TC	$255.07	$444.28	$625.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $470.88 / $693.83 / $909.15	Professional		$470.88	$693.83	$909.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.21 / $153.03 / $246.83	Professional	26	$87.21	$153.03	$246.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $240.35 / $413.95 / $674.60	Professional	TC	$240.35	$413.95	$674.60
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 $569.16 / $720.12 / $900.46	Professional		$569.16	$720.12	$900.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.41 / $181.12 / $239.72	Professional	26	$151.41	$181.12	$239.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $417.75 / $535.11 / $663.40	Professional	TC	$417.75	$535.11	$663.40
United Facility/Professional Professional Modifier Low / Median / High Price $278.54 / $425.20 / $985.24	Professional		$278.54	$425.20	$985.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.92 / $114.14 / $262.08	Professional	26	$77.92	$114.14	$262.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.81 / $315.20 / $723.15	Professional	TC	$188.81	$315.20	$723.15