Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $183.42 / $208.74 / $421.49	Facility	26	$183.42	$208.74	$421.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.65 / $522.50 / $2,193.31	Professional		$370.65	$522.50	$2,193.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.84 / $140.00 / $416.99	Professional	26	$86.84	$140.00	$416.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $363.59 / $758.48	Professional	TC	$281.41	$363.59	$758.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $374.29 / $710.29 / $1,110.01	Professional		$374.29	$710.29	$1,110.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.33 / $151.97 / $245.84	Professional	26	$83.33	$151.97	$245.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.14 / $564.72 / $863.13	Professional	TC	$289.14	$564.72	$863.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $675.60 / $766.80 / $930.97	Professional		$675.60	$766.80	$930.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $160.91 / $185.24 / $216.35	Professional	26	$160.91	$185.24	$216.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $509.73 / $581.71 / $714.65	Professional	TC	$509.73	$581.71	$714.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $580.21 / $711.45 / $1,072.53	Professional		$580.21	$711.45	$1,072.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.49 / $168.84 / $257.19	Professional	26	$134.49	$168.84	$257.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $412.57 / $587.59 / $820.13	Professional	TC	$412.57	$587.59	$820.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $124.95 / $165.87 / $170.85	Facility	26	$124.95	$165.87	$170.85
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $108.93 / $153.00 / $194.44	Professional	26	$108.93	$153.00	$194.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $399.65 / $591.61 / $791.70	Professional	TC	$399.65	$591.61	$791.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.55 / $96.55 / $96.55	Facility	26	$96.55	$96.55	$96.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $572.09 / $827.58 / $1,043.46	Professional		$572.09	$827.58	$1,043.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.86 / $153.10 / $245.84	Professional	26	$86.86	$153.10	$245.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $289.14 / $564.72 / $863.74	Professional	TC	$289.14	$564.72	$863.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $631.41 / $822.27 / $1,016.25	Professional		$631.41	$822.27	$1,016.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.41 / $179.71 / $239.72	Professional	26	$151.41	$179.71	$239.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $480.00 / $627.84 / $784.74	Professional	TC	$480.00	$627.84	$784.74
United Facility/Professional Professional Modifier Low / Median / High Price $334.68 / $511.86 / $1,124.02	Professional		$334.68	$511.86	$1,124.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.61 / $105.99 / $261.11	Professional	26	$77.61	$105.99	$261.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.07 / $393.16 / $864.81	Professional	TC	$257.07	$393.16	$864.81