Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $178.15 / $201.99 / $408.03	Facility	26	$178.15	$201.99	$408.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $282.20 / $484.91 / $908.42	Professional		$282.20	$484.91	$908.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.18 / $124.36 / $201.99	Professional	26	$82.18	$124.36	$201.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $200.02 / $348.53 / $539.96	Professional	TC	$200.02	$348.53	$539.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $297.17 / $607.27 / $929.99	Professional		$297.17	$607.27	$929.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.59 / $147.79 / $237.98	Professional	26	$80.59	$147.79	$237.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.74 / $464.96 / $724.55	Professional	TC	$214.74	$464.96	$724.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $538.80 / $615.29 / $739.88	Professional		$538.80	$615.29	$739.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $155.53 / $179.75 / $209.23	Professional	26	$155.53	$179.75	$209.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $378.51 / $435.52 / $530.65	Professional	TC	$378.51	$435.52	$530.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $449.26 / $621.03 / $1,006.72	Professional		$449.26	$621.03	$1,006.72
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.69 / $162.13 / $250.08	Professional	26	$129.69	$162.13	$250.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $306.36 / $436.32 / $865.52	Professional	TC	$306.36	$436.32	$865.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $121.52 / $160.31 / $166.16	Facility	26	$121.52	$160.31	$166.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $99.29 / $140.10 / $171.41	Professional	26	$99.29	$140.10	$171.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $322.30 / $476.87 / $826.70	Professional	TC	$322.30	$476.87	$826.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $458.32 / $682.63 / $876.65	Professional		$458.32	$682.63	$876.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $84.44 / $148.26 / $237.98	Professional	26	$84.44	$148.26	$237.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $218.41 / $459.48 / $712.31	Professional	TC	$218.41	$459.48	$712.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,538.06 / $1,538.06 / $1,538.06	Facility	26	$1,538.06	$1,538.06	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $503.94 / $679.37 / $867.77	Professional		$503.94	$679.37	$867.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.22 / $174.75 / $233.09	Professional	26	$147.22	$174.75	$233.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $356.71 / $480.81 / $710.65	Professional	TC	$356.71	$480.81	$710.65
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $454.48 / $931.67	Professional		$268.11	$454.48	$931.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.20 / $89.02 / $253.87	Professional	26	$75.20	$89.02	$253.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $192.64 / $356.82 / $649.09	Professional	TC	$192.64	$356.82	$649.09