Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $186.21 / $213.80	Facility	26	$104.71	$186.21	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $501.19 / $1,071.52	Professional		$371.54	$501.19	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $131.83 / $213.80	Professional	26	$85.11	$131.83	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $363.08 / $691.83	Professional	TC	$263.03	$363.08	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $616.60 / $1,230.27	Professional		$354.81	$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 / $181.97 / $218.78	Professional	26	$154.88	$181.97	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $575.44 / $707.95	Professional	TC	$489.78	$575.44	$707.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $758.58 / $1,047.13	Professional		$575.44	$758.58	$1,047.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $169.82 / $251.19	Professional	26	$138.04	$169.82	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $588.84 / $812.83	Professional	TC	$416.87	$588.84	$812.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $173.78	Facility	26	$138.04	$165.96	$173.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $154.88 / $186.21	Professional	26	$102.33	$154.88	$186.21
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $588.84 / $794.33	Professional	TC	$346.74	$588.84	$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 / $794.33 / $1,023.29	Professional		$630.96	$794.33	$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 / $776.25	Professional	TC	$478.63	$602.56	$776.25
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 / $245.47	Professional	26	$77.62	$109.65	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $436.52 / $891.25	Professional	TC	$257.04	$436.52	$891.25