Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $157.74 / $318.68	Facility	26	$127.92	$157.74	$318.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $1,474.49	Professional		$250.00	$475.00	$1,474.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.37 / $140.00 / $217.50	Professional	26	$65.37	$140.00	$217.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $507.50	Professional	TC	$187.50	$335.00	$507.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.99 / $491.81 / $790.17	Professional		$250.99	$491.81	$790.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.74 / $114.83 / $185.86	Professional	26	$61.74	$114.83	$185.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.61 / $375.26 / $611.01	Professional	TC	$186.61	$375.26	$611.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $453.27 / $516.51 / $623.39	Professional		$453.27	$516.51	$623.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $121.01 / $139.97 / $162.79	Professional	26	$121.01	$139.97	$162.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $328.53 / $376.51 / $460.60	Professional	TC	$328.53	$376.51	$460.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $377.77 / $522.22 / $839.79	Professional		$377.77	$522.22	$839.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.86 / $125.29 / $193.17	Professional	26	$100.86	$125.29	$193.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $265.80 / $378.56 / $718.58	Professional	TC	$265.80	$378.56	$718.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $94.08 / $124.74 / $128.63	Facility	26	$94.08	$124.74	$128.63
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.09 / $115.20 / $133.87	Professional	26	$78.09	$115.20	$133.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $273.36 / $396.60 / $672.03	Professional	TC	$273.36	$396.60	$672.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $380.76 / $573.34 / $733.64	Professional		$380.76	$573.34	$733.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.38 / $114.83 / $185.86	Professional	26	$64.38	$114.83	$185.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $189.79 / $366.35 / $611.01	Professional	TC	$189.79	$366.35	$611.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $423.74 / $572.71 / $748.46	Professional		$423.74	$572.71	$748.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.72 / $135.84 / $180.03	Professional	26	$113.72	$135.84	$180.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $310.02 / $417.63 / $602.77	Professional	TC	$310.02	$417.63	$602.77
United Facility/Professional Professional Modifier Low / Median / High Price $225.17 / $394.32 / $758.67	Professional		$225.17	$394.32	$758.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.03 / $81.59 / $196.08	Professional	26	$58.03	$81.59	$196.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.88 / $313.50 / $562.29	Professional	TC	$166.88	$313.50	$562.29