Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $177.83 / $204.17	Facility	26	$104.71	$177.83	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $933.25	Professional		$331.13	$501.19	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $125.89 / $204.17	Professional	26	$83.18	$125.89	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $338.84 / $645.65	Professional	TC	$239.88	$338.84	$645.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $616.60 / $1,230.27	Professional		$323.59	$616.60	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $117.49 / $239.88	Professional	26	$75.86	$117.49	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $489.78 / $1,047.13	Professional	TC	$239.88	$489.78	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $660.69 / $831.76	Professional		$575.44	$660.69	$831.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $173.78 / $208.93	Professional	26	$151.36	$173.78	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $501.19 / $630.96	Professional	TC	$426.58	$501.19	$630.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $691.83 / $1,047.13	Professional		$512.86	$691.83	$1,047.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $162.18 / $239.88	Professional	26	$131.83	$162.18	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $512.86 / $870.96	Professional	TC	$363.08	$512.86	$870.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $158.49 / $165.96	Facility	26	$131.83	$158.49	$165.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $316.23 / $457.09	Professional		$316.23	$316.23	$457.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $141.25 / $173.78	Professional	26	$100.00	$141.25	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $588.84 / $831.76	Professional	TC	$389.05	$588.84	$831.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $776.25 / $1,122.02	Professional		$338.84	$776.25	$1,122.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $165.96 / $239.88	Professional	26	$81.28	$165.96	$239.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $602.56 / $1,000.00	Professional	TC	$239.88	$602.56	$1,000.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	26	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $741.31 / $954.99	Professional		$562.34	$741.31	$954.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $173.78 / $223.87	Professional	26	$147.91	$173.78	$223.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $549.54 / $794.33	Professional	TC	$426.58	$549.54	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $575.44 / $1,071.52	Professional		$302.00	$575.44	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $104.71 / $251.19	Professional	26	$75.86	$104.71	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $457.09 / $794.33	Professional	TC	$229.09	$457.09	$794.33