Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.79 / $141.97 / $286.75	Facility	26	$124.79	$141.97	$286.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.26 / $371.00 / $1,224.35	Professional		$206.26	$371.00	$1,224.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.41 / $67.38 / $145.66	Professional	26	$51.41	$67.38	$145.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.78 / $290.93 / $493.22	Professional	TC	$154.78	$290.93	$493.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $280.89 / $470.20 / $765.07	Professional		$280.89	$470.20	$765.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.79 / $104.11 / $167.17	Professional	26	$56.79	$104.11	$167.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.32 / $368.69 / $597.89	Professional	TC	$218.32	$368.69	$597.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $502.94 / $579.32 / $694.19	Professional		$502.94	$579.32	$694.19
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 $389.97 / $452.80 / $546.75	Professional	TC	$389.97	$452.80	$546.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $406.69 / $484.20 / $805.44	Professional		$406.69	$484.20	$805.44
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 $315.43 / $449.25 / $631.32	Professional	TC	$315.43	$449.25	$631.32
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 $140.29 / $140.29 / $197.03	Professional		$140.29	$140.29	$197.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.95 / $103.82 / $128.02	Professional	26	$69.95	$103.82	$128.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $240.80 / $380.80 / $549.82	Professional	TC	$240.80	$380.80	$549.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $401.83 / $577.44 / $754.66	Professional		$401.83	$577.44	$754.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.48 / $104.27 / $167.17	Professional	26	$59.48	$104.27	$167.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $218.32 / $374.14 / $597.89	Professional	TC	$218.32	$374.14	$597.89
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 $474.61 / $587.14 / $751.37	Professional		$474.61	$587.14	$751.37
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.94 / $122.40 / $162.97	Professional	26	$102.94	$122.40	$162.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $371.67 / $456.95 / $588.40	Professional	TC	$371.67	$456.95	$588.40
United Facility/Professional Professional Modifier Low / Median / High Price $223.91 / $368.43 / $790.52	Professional		$223.91	$368.43	$790.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.84 / $65.06 / $177.17	Professional	26	$52.84	$65.06	$177.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $171.21 / $278.20 / $624.00	Professional	TC	$171.21	$278.20	$624.00