Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $182.69 / $208.74 / $421.49	Facility	26	$182.69	$208.74	$421.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.36 / $522.50 / $2,183.11	Professional		$371.36	$522.50	$2,183.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.37 / $140.00 / $322.00	Professional	26	$86.37	$140.00	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $274.52 / $363.17 / $730.74	Professional	TC	$274.52	$363.17	$730.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $375.76 / $708.65 / $1,103.21	Professional		$375.76	$708.65	$1,103.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.47 / $149.78 / $245.84	Professional	26	$82.47	$149.78	$245.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $290.61 / $560.90 / $857.29	Professional	TC	$290.61	$560.90	$857.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $678.92 / $765.35 / $935.61	Professional		$678.92	$765.35	$935.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $161.56 / $185.98 / $217.26	Professional	26	$161.56	$185.98	$217.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $512.38 / $581.65 / $718.33	Professional	TC	$512.38	$581.65	$718.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $579.72 / $711.96 / $1,074.57	Professional		$579.72	$711.96	$1,074.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.04 / $168.84 / $257.19	Professional	26	$135.04	$168.84	$257.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $414.69 / $590.63 / $824.36	Professional	TC	$414.69	$590.63	$824.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $124.95 / $166.53 / $170.85	Facility	26	$124.95	$166.53	$170.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.20 / $154.78 / $177.66	Professional	26	$103.20	$154.78	$177.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $400.37 / $561.91 / $793.44	Professional	TC	$400.37	$561.91	$793.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $571.01 / $825.98 / $1,042.46	Professional		$571.01	$825.98	$1,042.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.15 / $151.34 / $245.84	Professional	26	$85.15	$151.34	$245.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $290.61 / $560.90 / $897.97	Professional	TC	$290.61	$560.90	$897.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $632.61 / $823.81 / $1,020.16	Professional		$632.61	$823.81	$1,020.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.41 / $179.00 / $239.72	Professional	26	$151.41	$179.00	$239.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $481.19 / $626.59 / $785.97	Professional	TC	$481.19	$626.59	$785.97
United Facility/Professional Professional Modifier Low / Median / High Price $333.14 / $509.51 / $1,114.08	Professional		$333.14	$509.51	$1,114.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.31 / $109.44 / $260.48	Professional	26	$77.31	$109.44	$260.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.83 / $388.83 / $862.00	Professional	TC	$255.83	$388.83	$862.00