Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.28 / $128.52 / $283.44	Facility	26	$112.28	$128.52	$283.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $1,392.33	Professional		$250.00	$475.00	$1,392.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $128.00 / $309.00	Professional	26	$57.00	$128.00	$309.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $534.19	Professional	TC	$187.50	$335.00	$534.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.69 / $565.01 / $850.58	Professional		$239.69	$565.01	$850.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.13 / $102.92 / $165.21	Professional	26	$56.13	$102.92	$165.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.43 / $441.52 / $687.77	Professional	TC	$182.43	$441.52	$687.77
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $433.98 / $489.26 / $597.66	Professional		$433.98	$489.26	$597.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $108.29 / $125.00 / $145.72	Professional	26	$108.29	$125.00	$145.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $322.36 / $365.92 / $451.91	Professional	TC	$322.36	$365.92	$451.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $361.83 / $525.38 / $872.55	Professional		$361.83	$525.38	$872.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.21 / $113.60 / $172.83	Professional	26	$90.21	$113.60	$172.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.98 / $371.70 / $733.95	Professional	TC	$260.98	$371.70	$733.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.28 / $111.62 / $115.24	Facility	26	$84.28	$111.62	$115.24
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $160.34	Professional		$160.34	$160.34	$160.34
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.80 / $103.84 / $129.19	Professional	26	$68.80	$103.84	$129.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $262.31 / $487.00 / $832.88	Professional	TC	$262.31	$487.00	$832.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $384.06 / $563.44 / $826.26	Professional		$384.06	$563.44	$826.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.79 / $103.06 / $165.21	Professional	26	$58.79	$103.06	$165.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $184.28 / $431.74 / $687.77	Professional	TC	$184.28	$431.74	$687.77
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 $402.79 / $546.45 / $820.99	Professional		$402.79	$546.45	$820.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.75 / $120.98 / $161.07	Professional	26	$101.75	$120.98	$161.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $301.05 / $408.61 / $623.36	Professional	TC	$301.05	$408.61	$623.36
United Facility/Professional Professional Modifier Low / Median / High Price $212.59 / $415.80 / $744.67	Professional		$212.59	$415.80	$744.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $74.43 / $176.13	Professional	26	$51.93	$74.43	$176.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.13 / $296.57 / $556.55	Professional	TC	$160.13	$296.57	$556.55