Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.79 / $151.81 / $324.39	Facility	26	$124.79	$151.81	$324.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.90 / $475.00 / $1,222.20	Professional		$207.90	$475.00	$1,222.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.26 / $140.00 / $389.19	Professional	26	$71.26	$140.00	$389.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.16 / $335.00 / $507.50	Professional	TC	$131.16	$335.00	$507.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $209.71 / $417.92 / $700.00	Professional		$209.71	$417.92	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.31 / $126.79 / $204.54	Professional	26	$69.31	$126.79	$204.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.88 / $280.79 / $518.08	Professional	TC	$138.88	$280.79	$518.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $383.13 / $433.23 / $523.85	Professional		$383.13	$433.23	$523.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $133.72 / $153.94 / $179.97	Professional	26	$133.72	$153.94	$179.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.29 / $279.35 / $343.87	Professional	TC	$245.29	$279.35	$343.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $319.48 / $441.64 / $736.57	Professional		$319.48	$441.64	$736.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.54 / $145.86 / $213.48	Professional	26	$111.54	$145.86	$213.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $198.54 / $282.77 / $794.84	Professional	TC	$198.54	$282.77	$794.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.88 / $137.85 / $142.12	Facility	26	$103.88	$137.85	$142.12
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $178.16 / $178.16 / $178.16	Professional		$178.16	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.40 / $134.16 / $159.00	Professional	26	$95.40	$134.16	$159.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $192.89 / $279.48 / $674.54	Professional	TC	$192.89	$279.48	$674.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $321.85 / $466.44 / $607.25	Professional		$321.85	$466.44	$607.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $128.81 / $206.06	Professional	26	$72.33	$128.81	$206.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.88 / $278.14 / $501.65	Professional	TC	$138.88	$278.14	$501.65
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 $355.51 / $466.44 / $670.27	Professional		$355.51	$466.44	$670.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.69 / $149.99 / $198.98	Professional	26	$125.69	$149.99	$198.98
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $229.82 / $303.36 / $433.31	Professional	TC	$229.82	$303.36	$433.31
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $347.17 / $631.96	Professional		$187.43	$347.17	$631.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.55 / $99.00 / $217.55	Professional	26	$64.55	$99.00	$217.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $208.00 / $424.91	Professional	TC	$122.70	$208.00	$424.91