Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.49 / $129.97 / $279.14	Facility	26	$83.49	$129.97	$279.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $314.95 / $638.13	Professional		$171.00	$314.95	$638.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.90 / $83.13 / $298.00	Professional	26	$53.90	$83.13	$298.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $116.38 / $256.70 / $372.43	Professional	TC	$116.38	$256.70	$372.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $191.02 / $353.23 / $557.65	Professional		$191.02	$353.23	$557.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.36 / $108.34 / $175.93	Professional	26	$59.36	$108.34	$175.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.07 / $241.45 / $401.90	Professional	TC	$130.07	$241.45	$401.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $348.17 / $391.99 / $476.70	Professional		$348.17	$391.99	$476.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $114.54 / $132.47 / $154.11	Professional	26	$114.54	$132.47	$154.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $230.10 / $261.20 / $322.58	Professional	TC	$230.10	$261.20	$322.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $290.33 / $372.32 / $560.19	Professional		$290.33	$372.32	$560.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.54 / $121.03 / $183.00	Professional	26	$95.54	$121.03	$183.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.27 / $298.88 / $370.28	Professional	TC	$186.27	$298.88	$370.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.18 / $118.06 / $121.94	Facility	26	$89.18	$118.06	$121.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $155.88 / $155.88 / $155.88	Professional		$155.88	$155.88	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.76 / $109.20 / $142.31	Professional	26	$72.76	$109.20	$142.31
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $157.58 / $249.27 / $376.32	Professional	TC	$157.58	$249.27	$376.32
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $289.44 / $409.64 / $524.77	Professional		$289.44	$409.64	$524.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.15 / $108.51 / $176.02	Professional	26	$62.15	$108.51	$176.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $130.07 / $237.90 / $371.42	Professional	TC	$130.07	$237.90	$371.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $323.19 / $400.98 / $511.65	Professional		$323.19	$400.98	$511.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $128.06 / $170.55	Professional	26	$107.73	$128.06	$170.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $215.46 / $276.01 / $347.23	Professional	TC	$215.46	$276.01	$347.23
United Facility/Professional Professional Modifier Low / Median / High Price $165.04 / $254.60 / $559.44	Professional		$165.04	$254.60	$559.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.22 / $68.08 / $185.76	Professional	26	$55.22	$68.08	$185.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $193.57 / $372.95	Professional	TC	$109.82	$193.57	$372.95