Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.95 / $170.98 / $345.46	Facility	26	$118.95	$170.98	$345.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $214.99 / $475.00 / $1,303.14	Professional		$214.99	$475.00	$1,303.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.72 / $140.00 / $382.00	Professional	26	$70.72	$140.00	$382.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.12 / $335.00 / $613.77	Professional	TC	$159.12	$335.00	$613.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.01 / $493.19 / $758.75	Professional		$216.01	$493.19	$758.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.95 / $124.51 / $201.59	Professional	26	$67.95	$124.51	$201.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $146.22 / $351.53 / $575.41	Professional	TC	$146.22	$351.53	$575.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $392.37 / $445.68 / $536.98	Professional		$392.37	$445.68	$536.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.16 / $151.63 / $176.42	Professional	26	$131.16	$151.63	$176.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.18 / $294.06 / $360.57	Professional	TC	$257.18	$294.06	$360.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $334.88 / $476.34 / $757.90	Professional		$334.88	$476.34	$757.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.41 / $136.01 / $210.45	Professional	26	$109.41	$136.01	$210.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.15 / $296.45 / $725.40	Professional	TC	$208.15	$296.45	$725.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $101.92 / $135.19 / $139.36	Facility	26	$101.92	$135.19	$139.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $178.16	Professional		$160.34	$160.34	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.21 / $126.26 / $154.02	Professional	26	$83.21	$126.26	$154.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $219.45 / $416.30 / $605.88	Professional	TC	$219.45	$416.30	$605.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $331.61 / $501.32 / $707.28	Professional		$331.61	$501.32	$707.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.29 / $124.51 / $201.59	Professional	26	$71.29	$124.51	$201.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $148.68 / $344.43 / $561.27	Professional	TC	$148.68	$344.43	$561.27
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 $366.88 / $493.66 / $691.26	Professional		$366.88	$493.66	$691.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.89 / $147.16 / $196.13	Professional	26	$123.89	$147.16	$196.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $242.99 / $327.78 / $495.28	Professional	TC	$242.99	$327.78	$495.28
United Facility/Professional Professional Modifier Low / Median / High Price $194.49 / $443.80 / $655.30	Professional		$194.49	$443.80	$655.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.23 / $88.80 / $214.46	Professional	26	$63.23	$88.80	$214.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.68 / $255.59 / $450.65	Professional	TC	$130.68	$255.59	$450.65