Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $234.42 / $251.19	Facility	26	$128.82	$234.42	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $323.59 / $537.03	Professional		$239.88	$323.59	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $165.96	Professional	26	$91.20	$104.71	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $199.53 / $371.54	Professional	TC	$141.25	$199.53	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $562.34 / $1,023.29	Professional		$316.23	$562.34	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $194.98 / $281.84	Professional	26	$112.20	$194.98	$281.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $371.54 / $691.83	Professional	TC	$204.17	$371.54	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $691.83 / $794.33	Professional		$549.54	$691.83	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $218.78 / $257.04	Professional	26	$181.97	$218.78	$257.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $467.74 / $537.03	Professional	TC	$338.84	$467.74	$537.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $575.44 / $812.83	Professional		$323.59	$575.44	$812.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $190.55 / $263.03	Professional	26	$114.82	$190.55	$263.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $371.54 / $512.86	Professional	TC	$151.36	$371.54	$512.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $194.98 / $199.53	Facility	26	$162.18	$194.98	$199.53
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $213.80	Professional	26	$120.23	$169.82	$213.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $354.81 / $549.54	Professional	TC	$213.80	$354.81	$549.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $112.20 / $162.18	Facility	26	$24.55	$112.20	$162.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $575.44 / $812.83	Professional		$398.11	$575.44	$812.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $194.98 / $275.42	Professional	26	$128.82	$194.98	$275.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $371.54 / $630.96	Professional	TC	$223.87	$371.54	$630.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $562.34 / $794.33	Professional		$446.68	$562.34	$794.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $199.53 / $269.15	Professional	26	$162.18	$199.53	$269.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $354.81 / $524.81	Professional	TC	$281.84	$354.81	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $524.81 / $794.33	Professional		$281.84	$524.81	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $204.17 / $302.00	Professional	26	$120.23	$204.17	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $323.59 / $524.81	Professional	TC	$173.78	$323.59	$524.81