Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $169.82 / $190.55	Facility	26	$123.03	$169.82	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $1,096.48	Professional		$194.98	$398.11	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $117.49 / $199.53	Professional	26	$64.57	$117.49	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $251.19 / $416.87	Professional	TC	$125.89	$251.19	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $741.31	Professional		$218.78	$338.84	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $107.15 / $223.87	Professional	26	$67.61	$107.15	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $478.63	Professional	TC	$151.36	$223.87	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $478.63 / $602.56	Professional		$416.87	$478.63	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $158.49 / $194.98	Professional	26	$138.04	$158.49	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $323.59 / $407.38	Professional	TC	$275.42	$323.59	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $467.74 / $691.83	Professional		$371.54	$467.74	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $154.88 / $223.87	Professional	26	$120.23	$154.88	$223.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $316.23 / $457.09	Professional	TC	$234.42	$316.23	$457.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $147.91 / $151.36	Facility	26	$123.03	$147.91	$151.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Professional		$134.90	$134.90	$134.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $123.03 / $147.91	Professional	26	$89.13	$123.03	$147.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $281.84 / $302.00	Professional	TC	$239.88	$281.84	$302.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $489.78 / $691.83	Professional		$239.88	$489.78	$691.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $144.54 / $223.87	Professional	26	$74.13	$144.54	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $316.23 / $478.63	Professional	TC	$158.49	$316.23	$478.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $501.19 / $660.69	Professional		$407.38	$501.19	$660.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $158.49 / $204.17	Professional	26	$134.90	$158.49	$204.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $338.84 / $436.52	Professional	TC	$275.42	$338.84	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $478.63 / $1,122.02	Professional		$218.78	$478.63	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $229.09	Professional	26	$69.18	$100.00	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $354.81 / $1,023.29	Professional	TC	$147.91	$354.81	$1,023.29