Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $193.55 / $427.83	Facility	26	$105.78	$193.55	$427.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.60 / $438.48 / $1,524.65	Professional		$251.60	$438.48	$1,524.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.50 / $96.79 / $217.33	Professional	26	$76.50	$96.79	$217.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $318.13 / $509.48	Professional	TC	$171.62	$318.13	$509.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.57 / $560.72 / $925.36	Professional		$331.57	$560.72	$925.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.70 / $153.78 / $249.78	Professional	26	$84.70	$153.78	$249.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.11 / $415.14 / $675.58	Professional	TC	$239.11	$415.14	$675.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $613.75 / $693.39 / $844.10	Professional		$613.75	$693.39	$844.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $163.49 / $188.20 / $219.90	Professional	26	$163.49	$188.20	$219.90
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $445.23 / $506.06 / $624.22	Professional	TC	$445.23	$506.06	$624.22
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $496.90 / $653.21 / $978.78	Professional		$496.90	$653.21	$978.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $136.63 / $176.32 / $260.25	Professional	26	$136.63	$176.32	$260.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $360.26 / $513.10 / $716.16	Professional	TC	$360.26	$513.10	$716.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $126.42 / $168.53 / $176.85	Facility	26	$126.42	$168.53	$176.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $116.69 / $153.90 / $185.63	Professional	26	$116.69	$153.90	$185.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $283.01 / $459.03 / $564.60	Professional	TC	$283.01	$459.03	$564.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.06 / $98.06 / $98.06	Facility	26	$98.06	$98.06	$98.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $473.21 / $696.34 / $920.16	Professional		$473.21	$696.34	$920.16
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.90 / $153.78 / $249.78	Professional	26	$87.90	$153.78	$249.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $241.53 / $415.14 / $675.58	Professional	TC	$241.53	$415.14	$675.58
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 $572.16 / $707.82 / $900.46	Professional		$572.16	$707.82	$900.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.22 / $181.83 / $242.56	Professional	26	$153.22	$181.83	$242.56
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $418.95 / $524.79 / $663.25	Professional	TC	$418.95	$524.79	$663.25
United Facility/Professional Professional Modifier Low / Median / High Price $266.25 / $473.21 / $978.20	Professional		$266.25	$473.21	$978.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.81 / $110.25 / $265.63	Professional	26	$78.81	$110.25	$265.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.38 / $308.43 / $704.21	Professional	TC	$194.38	$308.43	$704.21