Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $225.25 / $225.25 / $250.28	Facility	26	$225.25	$225.25	$250.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $247.17 / $347.32 / $655.13	Professional		$247.17	$347.32	$655.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.90 / $108.90 / $225.25	Professional	26	$93.90	$108.90	$225.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.85 / $253.00 / $443.01	Professional	TC	$151.85	$253.00	$443.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.59 / $114.59 / $114.59	Facility	26	$114.59	$114.59	$114.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $349.28 / $599.47 / $809.73	Professional		$349.28	$599.47	$809.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.44 / $204.66 / $284.95	Professional	26	$128.44	$204.66	$284.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.31 / $390.09 / $546.04	Professional	TC	$223.31	$390.09	$546.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $522.80 / $681.67 / $788.02	Professional		$522.80	$681.67	$788.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $175.92 / $229.38 / $258.64	Professional	26	$175.92	$229.38	$258.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $339.90 / $450.89 / $529.38	Professional	TC	$339.90	$450.89	$529.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $368.28 / $540.02 / $864.45	Professional		$368.28	$540.02	$864.45
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $144.59 / $182.28 / $316.16	Professional	26	$144.59	$182.28	$316.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $168.02 / $329.92 / $607.95	Professional	TC	$168.02	$329.92	$607.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $144.87 / $196.98 / $200.33	Facility	26	$144.87	$196.98	$200.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $118.19 / $170.28 / $221.26	Professional	26	$118.19	$170.28	$221.26
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $202.13 / $352.05 / $543.46	Professional	TC	$202.13	$352.05	$543.46
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $114.59 / $114.59 / $114.59	Facility	26	$114.59	$114.59	$114.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $378.61 / $588.72 / $783.39	Professional		$378.61	$588.72	$783.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $132.18 / $209.20 / $284.95	Professional	26	$132.18	$209.20	$284.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $218.65 / $404.26 / $546.04	Professional	TC	$218.65	$404.26	$546.04
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $443.88 / $547.86 / $778.85	Professional		$443.88	$547.86	$778.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $160.38 / $197.95 / $281.41	Professional	26	$160.38	$197.95	$281.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $283.47 / $349.91 / $514.23	Professional	TC	$283.47	$349.91	$514.23
United Facility/Professional Professional Modifier Low / Median / High Price $383.74 / $592.02 / $912.41	Professional		$383.74	$592.02	$912.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.16 / $214.32 / $313.02	Professional	26	$151.16	$214.32	$313.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $236.51 / $371.13 / $558.54	Professional	TC	$236.51	$371.13	$558.54