Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.65 / $135.87 / $281.20	Facility	26	$104.65	$135.87	$281.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.73 / $360.53 / $1,101.15	Professional		$231.73	$360.53	$1,101.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.86 / $81.48 / $238.00	Professional	26	$54.86	$81.48	$238.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $285.00 / $502.02	Professional	TC	$171.62	$285.00	$502.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.47 / $429.16 / $698.06	Professional		$252.47	$429.16	$698.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.36 / $108.34 / $174.84	Professional	26	$59.36	$108.34	$174.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.41 / $320.39 / $530.04	Professional	TC	$186.41	$320.39	$530.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $463.11 / $536.65 / $637.88	Professional		$463.11	$536.65	$637.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.54 / $132.47 / $154.11	Professional	26	$114.54	$132.47	$154.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $345.04 / $404.18 / $483.76	Professional	TC	$345.04	$404.18	$483.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $374.67 / $458.68 / $744.15	Professional		$374.67	$458.68	$744.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.54 / $119.26 / $183.00	Professional	26	$95.54	$119.26	$183.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.13 / $397.55 / $558.83	Professional	TC	$279.13	$397.55	$558.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.18 / $118.06 / $121.94	Facility	26	$89.18	$118.06	$121.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $145.07 / $198.80	Professional		$140.29	$145.07	$198.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.76 / $110.12 / $135.75	Professional	26	$72.76	$110.12	$135.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $203.33 / $331.35 / $480.39	Professional	TC	$203.33	$331.35	$480.39
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $355.96 / $531.84 / $686.23	Professional		$355.96	$531.84	$686.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.15 / $109.12 / $176.02	Professional	26	$62.15	$109.12	$176.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.41 / $325.77 / $530.04	Professional	TC	$186.41	$325.77	$530.04
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 $438.10 / $528.66 / $693.38	Professional		$438.10	$528.66	$693.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $128.06 / $170.55	Professional	26	$107.73	$128.06	$170.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $325.02 / $399.75 / $523.02	Professional	TC	$325.02	$399.75	$523.02
United Facility/Professional Professional Modifier Low / Median / High Price $200.94 / $336.27 / $719.38	Professional		$200.94	$336.27	$719.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.28 / $84.92 / $187.08	Professional	26	$55.28	$84.92	$187.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.41 / $219.30 / $533.98	Professional	TC	$144.41	$219.30	$533.98