Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $178.95 / $382.29	Facility	26	$105.78	$178.95	$382.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.29 / $431.44 / $1,199.43	Professional		$223.29	$431.44	$1,199.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $91.39 / $384.82	Professional	26	$73.75	$91.39	$384.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.62 / $346.05 / $976.14	Professional	TC	$171.62	$346.05	$976.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.45 / $545.41 / $940.76	Professional		$304.45	$545.41	$940.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.25 / $147.44 / $240.93	Professional	26	$80.25	$147.44	$240.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $220.12 / $392.22 / $701.17	Professional	TC	$220.12	$392.22	$701.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $554.70 / $619.77 / $761.95	Professional		$554.70	$619.77	$761.95
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $157.46 / $181.29 / $211.85	Professional	26	$157.46	$181.29	$211.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $392.37 / $445.42 / $550.10	Professional	TC	$392.37	$445.42	$550.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $448.85 / $639.27 / $980.76	Professional		$448.85	$639.27	$980.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.29 / $166.16 / $252.12	Professional	26	$131.29	$166.16	$252.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $317.56 / $452.28 / $693.16	Professional	TC	$317.56	$452.28	$693.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $122.01 / $162.32 / $167.50	Facility	26	$122.01	$162.32	$167.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $155.88	Professional		$155.88	$155.88	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $100.50 / $149.58 / $183.75	Professional	26	$100.50	$149.58	$183.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $241.92 / $404.18 / $856.02	Professional	TC	$241.92	$404.18	$856.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $445.88 / $662.04 / $871.83	Professional		$445.88	$662.04	$871.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.47 / $148.97 / $240.93	Professional	26	$83.47	$148.97	$240.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $220.12 / $388.94 / $723.57	Professional	TC	$220.12	$388.94	$723.57
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 $513.51 / $670.34 / $942.45	Professional		$513.51	$670.34	$942.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $148.43 / $176.17 / $234.98	Professional	26	$148.43	$176.17	$234.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $365.09 / $471.95 / $688.32	Professional	TC	$365.09	$471.95	$688.32
United Facility/Professional Professional Modifier Low / Median / High Price $251.97 / $491.61 / $888.88	Professional		$251.97	$491.61	$888.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.05 / $97.86 / $255.93	Professional	26	$76.05	$97.86	$255.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.71 / $359.53 / $631.95	Professional	TC	$175.71	$359.53	$631.95