Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $163.63 / $191.50 / $377.93	Facility	26	$163.63	$191.50	$377.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.37 / $475.00 / $1,320.50	Professional		$177.37	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.43 / $116.83 / $187.04	Professional	26	$61.43	$116.83	$187.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.01 / $276.50 / $393.47	Professional	TC	$105.01	$276.50	$393.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.36 / $443.28 / $663.78	Professional		$236.36	$443.28	$663.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.68 / $136.44 / $220.28	Professional	26	$74.68	$136.44	$220.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.75 / $304.43 / $455.30	Professional	TC	$159.75	$304.43	$455.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $438.75 / $499.20 / $600.75	Professional		$438.75	$499.20	$600.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $144.10 / $165.88 / $193.89	Professional	26	$144.10	$165.88	$193.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $290.20 / $333.33 / $406.89	Professional	TC	$290.20	$333.33	$406.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $354.92 / $454.23 / $705.53	Professional		$354.92	$454.23	$705.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.09 / $159.63 / $229.77	Professional	26	$120.09	$159.63	$229.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.83 / $329.21 / $466.81	Professional	TC	$234.83	$329.21	$466.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $98.56 / $148.53 / $152.09	Facility	26	$98.56	$148.53	$152.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $160.34 / $302.39	Professional		$160.34	$160.34	$302.39
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.12 / $123.20 / $150.08	Professional	26	$89.12	$123.20	$150.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $241.98 / $290.20 / $320.39	Professional	TC	$241.98	$290.20	$320.39
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $342.48 / $499.50 / $660.56	Professional		$342.48	$499.50	$660.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $76.34 / $136.44 / $220.28	Professional	26	$76.34	$136.44	$220.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.31 / $307.00 / $468.09	Professional	TC	$165.31	$307.00	$468.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $777.03 / $777.03 / $777.03	Facility	26	$777.03	$777.03	$777.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $411.17 / $524.14 / $660.22	Professional		$411.17	$524.14	$660.22
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $135.26 / $167.33 / $214.14	Professional	26	$135.26	$167.33	$214.14
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.91 / $353.67 / $441.12	Professional	TC	$275.91	$353.67	$441.12
United Facility/Professional Professional Modifier Low / Median / High Price $217.18 / $467.27 / $762.59	Professional		$217.18	$467.27	$762.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.63 / $100.68 / $234.15	Professional	26	$69.63	$100.68	$234.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.55 / $387.59 / $511.71	Professional	TC	$147.55	$387.59	$511.71