Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.08 / $141.97 / $286.75	Facility	26	$124.08	$141.97	$286.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $179.50 / $371.00 / $563.50	Professional		$179.50	$371.00	$563.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.48 / $67.73 / $145.66	Professional	26	$51.48	$67.73	$145.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.01 / $285.00 / $489.53	Professional	TC	$128.01	$285.00	$489.53
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 $215.90 / $477.71 / $667.14	Professional		$215.90	$477.71	$667.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.95 / $102.42 / $167.17	Professional	26	$55.95	$102.42	$167.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.69 / $365.92 / $512.78	Professional	TC	$159.69	$365.92	$512.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $391.94 / $439.69 / $538.57	Professional		$391.94	$439.69	$538.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.95 / $126.52 / $146.51	Professional	26	$108.95	$126.52	$146.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $279.64 / $317.45 / $392.06	Professional	TC	$279.64	$317.45	$392.06
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $317.02 / $451.53 / $630.22	Professional		$317.02	$451.53	$630.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.73 / $114.57 / $173.85	Professional	26	$90.73	$114.57	$173.85
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $226.30 / $322.30 / $484.22	Professional	TC	$226.30	$322.30	$484.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.77 / $112.30 / $116.58	Facility	26	$84.77	$112.30	$116.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.55 / $104.40 / $129.63	Professional	26	$69.55	$104.40	$129.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $253.94 / $359.40 / $569.10	Professional	TC	$253.94	$359.40	$569.10
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 $346.47 / $491.47 / $638.75	Professional		$346.47	$491.47	$638.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.93 / $103.49 / $167.17	Professional	26	$57.93	$103.49	$167.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.69 / $360.69 / $517.24	Professional	TC	$159.69	$360.69	$517.24
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 $363.29 / $488.86 / $629.10	Professional		$363.29	$488.86	$629.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.34 / $122.40 / $162.02	Professional	26	$102.34	$122.40	$162.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $260.95 / $353.64 / $491.39	Professional	TC	$260.95	$353.64	$491.39
United Facility/Professional Professional Modifier Low / Median / High Price $201.24 / $315.88 / $673.78	Professional		$201.24	$315.88	$673.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.24 / $76.06 / $177.49	Professional	26	$52.24	$76.06	$177.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.47 / $251.69 / $495.63	Professional	TC	$148.47	$251.69	$495.63