Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $128.82 / $154.88	Facility	26	$93.33	$128.82	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $676.08	Professional		$223.87	$346.74	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $141.25	Professional	26	$51.29	$64.57	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $239.88 / $467.74	Professional	TC	$165.96	$239.88	$467.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $457.09 / $870.96	Professional		$263.03	$457.09	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $169.82	Professional	26	$53.70	$85.11	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $346.74 / $691.83	Professional	TC	$208.93	$346.74	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $562.34 / $691.83	Professional		$489.78	$562.34	$691.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $147.91	Professional	26	$107.15	$123.03	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $436.52 / $549.54	Professional	TC	$380.19	$436.52	$549.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $154.88	Facility	26	$154.88	$154.88	$154.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $537.03 / $758.58	Professional		$416.87	$537.03	$758.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $169.82	Professional	26	$79.43	$114.82	$169.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $426.58 / $616.60	Professional	TC	$323.59	$426.58	$616.60
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $112.20 / $117.49	Facility	26	$93.33	$112.20	$117.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $257.04 / $257.04	Professional		$165.96	$257.04	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $97.72 / $123.03	Professional	26	$69.18	$97.72	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $537.03	Professional	TC	$245.47	$363.08	$537.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $562.34 / $758.58	Professional		$288.40	$562.34	$758.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $117.49 / $169.82	Professional	26	$56.23	$117.49	$169.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $436.52 / $645.65	Professional	TC	$208.93	$436.52	$645.65
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 $457.09 / $549.54 / $724.44	Professional		$457.09	$549.54	$724.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $123.03 / $158.49	Professional	26	$102.33	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $436.52 / $575.44	Professional	TC	$363.08	$436.52	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $389.05 / $776.25	Professional		$234.42	$389.05	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $165.96	Professional	26	$52.48	$74.13	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $309.03 / $616.60	Professional	TC	$181.97	$309.03	$616.60