Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $135.12 / $148.44 / $299.87	Facility	26	$135.12	$148.44	$299.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.16 / $371.00 / $1,258.20	Professional		$195.16	$371.00	$1,258.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.50 / $79.80 / $183.36	Professional	26	$53.50	$79.80	$183.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.36 / $289.73 / $434.15	Professional	TC	$138.36	$289.73	$434.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $235.05 / $518.78 / $720.71	Professional		$235.05	$518.78	$720.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.58 / $120.00 / $175.04	Professional	26	$60.58	$120.00	$175.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.74 / $397.62 / $565.33	Professional	TC	$174.74	$397.62	$565.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $421.49 / $478.03 / $579.51	Professional		$421.49	$478.03	$579.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.90 / $131.75 / $153.18	Professional	26	$113.90	$131.75	$153.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $304.08 / $346.29 / $426.33	Professional	TC	$304.08	$346.29	$426.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $351.37 / $510.00 / $677.94	Professional		$351.37	$510.00	$677.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.01 / $127.00 / $181.98	Professional	26	$95.01	$127.00	$181.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $246.05 / $350.43 / $489.11	Professional	TC	$246.05	$350.43	$489.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.83 / $117.42 / $138.02	Facility	26	$97.83	$117.42	$138.02
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.95 / $119.26 / $142.13	Professional	26	$89.95	$119.26	$142.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $270.06 / $402.42 / $573.99	Professional	TC	$270.06	$402.42	$573.99
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $372.73 / $538.08 / $679.18	Professional		$372.73	$538.08	$679.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.78 / $122.02 / $175.04	Professional	26	$61.78	$122.02	$175.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $174.74 / $392.62 / $565.33	Professional	TC	$174.74	$392.62	$565.33
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 $392.62 / $530.77 / $687.58	Professional		$392.62	$530.77	$687.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.13 / $131.84 / $169.60	Professional	26	$107.13	$131.84	$169.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $285.48 / $386.46 / $526.44	Professional	TC	$285.48	$386.46	$526.44
United Facility/Professional Professional Modifier Low / Median / High Price $213.81 / $343.04 / $719.29	Professional		$213.81	$343.04	$719.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.91 / $80.48 / $185.01	Professional	26	$54.91	$80.48	$185.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.90 / $269.35 / $534.55	Professional	TC	$158.90	$269.35	$534.55