Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.52 / $148.93 / $305.94	Facility	26	$91.52	$148.93	$305.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $237.75 / $410.67 / $1,321.00	Professional		$237.75	$410.67	$1,321.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.00 / $86.00 / $197.65	Professional	26	$60.00	$86.00	$197.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.94 / $346.55 / $963.40	Professional	TC	$171.94	$346.55	$963.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $286.35 / $482.99 / $793.59	Professional		$286.35	$482.99	$793.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.05 / $119.68 / $192.13	Professional	26	$65.05	$119.68	$192.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.76 / $368.63 / $600.84	Professional	TC	$213.76	$368.63	$600.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $520.71 / $600.60 / $717.48	Professional		$520.71	$600.60	$717.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $125.55 / $145.65 / $168.89	Professional	26	$125.55	$145.65	$168.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $391.29 / $454.95 / $548.59	Professional	TC	$391.29	$454.95	$548.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $426.72 / $556.36 / $834.63	Professional		$426.72	$556.36	$834.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.61 / $130.65 / $200.28	Professional	26	$104.61	$130.65	$200.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.49 / $450.75 / $634.38	Professional	TC	$316.49	$450.75	$634.38
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.00 / $129.41 / $134.00	Facility	26	$98.00	$129.41	$134.00
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $155.88 / $155.88	Professional		$140.29	$155.88	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $84.00 / $119.40 / $151.74	Professional	26	$84.00	$119.40	$151.74
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $234.37 / $362.47 / $595.02	Professional	TC	$234.37	$362.47	$595.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $75.64 / $75.64 / $75.64	Facility	26	$75.64	$75.64	$75.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $405.13 / $598.32 / $789.45	Professional		$405.13	$598.32	$789.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.09 / $119.94 / $192.74	Professional	26	$68.09	$119.94	$192.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $214.38 / $370.47 / $600.84	Professional	TC	$214.38	$370.47	$600.84
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 $491.37 / $598.47 / $777.90	Professional		$491.37	$598.47	$777.90
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.90 / $140.79 / $186.66	Professional	26	$117.90	$140.79	$186.66
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $373.12 / $462.38 / $596.87	Professional	TC	$373.12	$462.38	$596.87
United Facility/Professional Professional Modifier Low / Median / High Price $228.34 / $377.90 / $812.12	Professional		$228.34	$377.90	$812.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.78 / $78.29 / $204.10	Professional	26	$60.78	$78.29	$204.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.88 / $351.59 / $646.44	Professional	TC	$172.88	$351.59	$646.44