Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.90 / $118.87 / $254.37	Facility	26	$94.90	$118.87	$254.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.13 / $322.50 / $1,127.00	Professional		$224.13	$322.50	$1,127.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $83.57 / $217.00	Professional	26	$50.07	$83.57	$217.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.90 / $255.84 / $482.55	Professional	TC	$154.90	$255.84	$482.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.70 / $421.26 / $675.16	Professional		$247.70	$421.26	$675.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $99.29 / $159.18	Professional	26	$54.11	$99.29	$159.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.17 / $318.39 / $532.88	Professional	TC	$187.17	$318.39	$532.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $455.30 / $526.04 / $627.92	Professional		$455.30	$526.04	$627.92
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.41 / $120.41 / $140.47	Professional	26	$104.41	$120.41	$140.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $347.69 / $405.60 / $487.47	Professional	TC	$347.69	$405.60	$487.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $368.26 / $428.35 / $729.67	Professional		$368.26	$428.35	$729.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.99 / $108.54 / $166.74	Professional	26	$86.99	$108.54	$166.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.27 / $400.60 / $559.14	Professional	TC	$281.27	$400.60	$559.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $81.34 / $107.62 / $111.22	Facility	26	$81.34	$107.62	$111.22
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $155.88	Professional		$155.88	$155.88	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $100.69 / $122.25	Professional	26	$66.73	$100.69	$122.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $215.23 / $320.95 / $430.32	Professional	TC	$215.23	$320.95	$430.32
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $348.49 / $521.62 / $668.67	Professional		$348.49	$521.62	$668.67
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.41 / $99.42 / $160.29	Professional	26	$56.41	$99.42	$160.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $187.76 / $321.08 / $532.99	Professional	TC	$187.76	$321.08	$532.99
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 $430.32 / $500.61 / $681.20	Professional		$430.32	$500.61	$681.20
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $98.15 / $117.45 / $155.38	Professional	26	$98.15	$117.45	$155.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $326.83 / $397.91 / $525.86	Professional	TC	$326.83	$397.91	$525.86
United Facility/Professional Professional Modifier Low / Median / High Price $199.48 / $309.33 / $703.88	Professional		$199.48	$309.33	$703.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $65.12 / $169.52	Professional	26	$50.31	$65.12	$169.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.26 / $236.74 / $544.26	Professional	TC	$149.26	$236.74	$544.26