Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.00 / $181.52 / $440.95	Facility	26	$86.00	$181.52	$440.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $299.24 / $367.26 / $1,373.97	Professional		$299.24	$367.26	$1,373.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.01 / $113.23 / $338.00	Professional	26	$81.01	$113.23	$338.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $226.93 / $285.00 / $784.07	Professional	TC	$226.93	$285.00	$784.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $327.54 / $554.59 / $907.46	Professional		$327.54	$554.59	$907.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.41 / $155.53 / $250.76	Professional	26	$85.41	$155.53	$250.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.78 / $395.62 / $662.09	Professional	TC	$239.78	$395.62	$662.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $606.07 / $696.97 / $833.32	Professional		$606.07	$696.97	$833.32
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $164.78 / $189.68 / $221.75	Professional	26	$164.78	$189.68	$221.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $436.22 / $507.51 / $611.58	Professional	TC	$436.22	$507.51	$611.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $490.48 / $535.07 / $967.83	Professional		$490.48	$535.07	$967.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.69 / $182.35 / $262.29	Professional	26	$137.69	$182.35	$262.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $352.79 / $500.92 / $705.54	Professional	TC	$352.79	$500.92	$705.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $127.40 / $169.85 / $174.20	Facility	26	$127.40	$169.85	$174.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $262.88 / $268.35 / $298.17	Professional		$262.88	$268.35	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $117.45 / $154.97 / $197.37	Professional	26	$117.45	$154.97	$197.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $284.74 / $414.73 / $487.49	Professional	TC	$284.74	$414.73	$487.49
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $463.88 / $690.20 / $896.78	Professional		$463.88	$690.20	$896.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.93 / $155.65 / $250.76	Professional	26	$86.93	$155.65	$250.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $242.63 / $412.09 / $667.71	Professional	TC	$242.63	$412.09	$667.71
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 $569.77 / $649.13 / $902.02	Professional		$569.77	$649.13	$902.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $154.41 / $183.95 / $244.46	Professional	26	$154.41	$183.95	$244.46
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $415.36 / $484.95 / $657.57	Professional	TC	$415.36	$484.95	$657.57
United Facility/Professional Professional Modifier Low / Median / High Price $268.14 / $432.11 / $951.96	Professional		$268.14	$432.11	$951.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $121.51 / $267.29	Professional	26	$79.45	$121.51	$267.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $196.49 / $271.23 / $718.99	Professional	TC	$196.49	$271.23	$718.99