Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $173.78 / $263.03	Facility	26	$104.71	$173.78	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $457.09 / $1,023.29	Professional		$213.80	$457.09	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $371.54	Professional	26	$70.79	$141.25	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $302.00 / $524.81	Professional	TC	$144.54	$302.00	$524.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $436.52 / $891.25	Professional		$208.93	$436.52	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $102.33 / $208.93	Professional	26	$64.57	$102.33	$208.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $331.13 / $758.58	Professional	TC	$138.04	$331.13	$758.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $426.58 / $537.03	Professional		$371.54	$426.58	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $144.54 / $177.83	Professional	26	$125.89	$144.54	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $288.40 / $363.08	Professional	TC	$245.47	$288.40	$363.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $263.03	Facility	26	$104.71	$138.04	$263.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $851.14	Professional		$331.13	$467.74	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $213.80	Professional	26	$102.33	$138.04	$213.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $302.00 / $724.44	Professional	TC	$218.78	$302.00	$724.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $134.90 / $138.04	Facility	26	$112.20	$134.90	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $154.88	Professional	26	$83.18	$125.89	$154.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $398.11 / $660.69	Professional	TC	$245.47	$398.11	$660.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $77.62 / $112.20	Facility	26	$16.98	$77.62	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $501.19 / $794.33	Professional		$223.87	$501.19	$794.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $141.25 / $204.17	Professional	26	$67.61	$141.25	$204.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $371.54 / $741.31	Professional	TC	$138.04	$371.54	$741.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $489.78 / $691.83	Professional		$363.08	$489.78	$691.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $147.91 / $186.21	Professional	26	$123.03	$147.91	$186.21
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $331.13 / $501.19	Professional	TC	$245.47	$331.13	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $691.83	Professional		$194.98	$398.11	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $89.13 / $208.93	Professional	26	$63.10	$89.13	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $281.84 / $575.44	Professional	TC	$131.83	$281.84	$575.44