Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $154.88 / $177.83	Facility	26	$104.71	$154.88	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $501.19 / $1,230.27	Professional		$269.15	$501.19	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $120.23 / $263.03	Professional	26	$70.79	$120.23	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $338.84 / $549.54	Professional	TC	$194.98	$338.84	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $512.86 / $1,096.48	Professional		$263.03	$512.86	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $100.00 / $213.80	Professional	26	$58.88	$100.00	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $416.87 / $1,000.00	Professional	TC	$190.55	$416.87	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $537.03 / $676.08	Professional		$478.63	$537.03	$676.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $151.36 / $181.97	Professional	26	$131.83	$151.36	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $398.11 / $501.19	Professional	TC	$338.84	$398.11	$501.19
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $128.82 / $141.25	Facility	26	$104.71	$128.82	$141.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $575.44 / $933.25	Professional		$426.58	$575.44	$933.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $213.80	Professional	26	$104.71	$141.25	$213.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $416.87 / $741.31	Professional	TC	$302.00	$416.87	$741.31
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $134.90 / $141.25	Facility	26	$97.72	$134.90	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $102.33 / $147.91	Professional	26	$77.62	$102.33	$147.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $588.84 / $870.96	Professional	TC	$323.59	$588.84	$870.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $81.28 / $114.82	Facility	26	$17.38	$81.28	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $630.96 / $1,023.29	Professional		$288.40	$630.96	$1,023.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $120.23 / $208.93	Professional	26	$69.18	$120.23	$208.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $512.86 / $1,071.52	Professional	TC	$190.55	$512.86	$1,071.52
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.14 / $851.14 / $851.14	Facility	26	$851.14	$851.14	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $616.60 / $891.25	Professional		$457.09	$616.60	$891.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $151.36 / $190.55	Professional	26	$104.71	$151.36	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $446.68 / $676.08	Professional	TC	$331.13	$446.68	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $467.74 / $870.96	Professional		$239.88	$467.74	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $190.55	Professional	26	$52.48	$81.28	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $371.54 / $691.83	Professional	TC	$173.78	$371.54	$691.83