Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $130.72 / $282.36	Facility	26	$105.78	$130.72	$282.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $277.86 / $983.61	Professional		$171.00	$277.86	$983.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $84.08 / $216.64	Professional	26	$55.15	$84.08	$216.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.03 / $202.05 / $558.89	Professional	TC	$102.03	$202.05	$558.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.47 / $396.73 / $546.86	Professional		$176.47	$396.73	$546.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.05 / $108.94 / $175.83	Professional	26	$60.05	$108.94	$175.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.61 / $266.97 / $394.33	Professional	TC	$113.61	$266.97	$394.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $319.11 / $356.76 / $435.86	Professional		$319.11	$356.76	$435.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $115.83 / $133.33 / $155.91	Professional	26	$115.83	$133.33	$155.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.72 / $226.71 / $279.98	Professional	TC	$199.72	$226.71	$279.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $266.14 / $387.63 / $513.52	Professional		$266.14	$387.63	$513.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.61 / $119.93 / $185.01	Professional	26	$96.61	$119.93	$185.01
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.72 / $230.32 / $321.47	Professional	TC	$161.72	$230.32	$321.47
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.67 / $119.39 / $122.61	Facility	26	$89.67	$119.39	$122.61
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.94 / $86.94 / $119.08	Professional		$86.94	$86.94	$119.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.45 / $109.20 / $132.58	Professional	26	$83.45	$109.20	$132.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $185.56 / $299.56 / $380.62	Professional	TC	$185.56	$299.56	$380.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $281.47 / $407.09 / $539.09	Professional		$281.47	$407.09	$539.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.64 / $108.94 / $177.99	Professional	26	$62.64	$108.94	$177.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.61 / $266.97 / $394.33	Professional	TC	$113.61	$266.97	$394.33
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $294.45 / $398.08 / $540.88	Professional		$294.45	$398.08	$540.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $108.93 / $128.77 / $172.45	Professional	26	$108.93	$128.77	$172.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $185.54 / $252.71 / $378.17	Professional	TC	$185.54	$252.71	$378.17
United Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $287.74 / $582.05	Professional		$173.02	$287.74	$582.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.52 / $75.34 / $186.79	Professional	26	$55.52	$75.34	$186.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.50 / $188.43 / $389.53	Professional	TC	$117.50	$188.43	$389.53