Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $181.97 / $213.80	Facility	26	$104.71	$181.97	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $549.54 / $1,548.82	Professional		$371.54	$549.54	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $275.42	Professional	26	$85.11	$141.25	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $371.54 / $691.83	Professional	TC	$263.03	$371.54	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $616.60 / $1,230.27	Professional		$363.08	$616.60	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $125.89 / $251.19	Professional	26	$79.43	$125.89	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $501.19 / $977.24	Professional	TC	$275.42	$501.19	$977.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $741.31 / $933.25	Professional		$645.65	$741.31	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $177.83 / $218.78	Professional	26	$154.88	$177.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $575.44 / $724.44	Professional	TC	$489.78	$575.44	$724.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $758.58 / $1,071.52	Professional		$575.44	$758.58	$1,071.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $169.82 / $251.19	Professional	26	$134.90	$169.82	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $588.84 / $831.76	Professional	TC	$416.87	$588.84	$831.76
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $169.82	Facility	26	$138.04	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $151.36 / $177.83	Professional	26	$107.15	$151.36	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $562.34 / $794.33	Professional	TC	$398.11	$562.34	$794.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $776.25 / $1,096.48	Professional		$380.19	$776.25	$1,096.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $173.78 / $251.19	Professional	26	$83.18	$173.78	$251.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $630.96 / $954.99	Professional	TC	$275.42	$630.96	$954.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $776.25 / $1,023.29	Professional		$630.96	$776.25	$1,023.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $177.83 / $229.09	Professional	26	$151.36	$177.83	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $602.56 / $794.33	Professional	TC	$478.63	$602.56	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $512.86 / $1,122.02	Professional		$331.13	$512.86	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $239.88	Professional	26	$77.62	$109.65	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $436.52 / $870.96	Professional	TC	$257.04	$436.52	$870.96