Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $123.03 / $173.78	Facility	26	$87.10	$123.03	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $316.23 / $562.34	Professional		$186.21	$316.23	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $158.49	Professional	26	$52.48	$83.18	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $380.19	Professional	TC	$131.83	$223.87	$380.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $363.08 / $758.58	Professional		$190.55	$363.08	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $89.13 / $165.96	Professional	26	$52.48	$89.13	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $275.42 / $575.44	Professional	TC	$138.04	$275.42	$575.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $398.11 / $501.19	Professional		$346.74	$398.11	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $112.20 / $138.04	Professional	26	$97.72	$112.20	$138.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $288.40 / $363.08	Professional	TC	$245.47	$288.40	$363.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $141.25 / $467.74	Facility	26	$107.15	$141.25	$467.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $426.58 / $616.60	Professional		$295.12	$426.58	$616.60
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $158.49	Professional	26	$69.18	$112.20	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $295.12 / $446.68	Professional	TC	$208.93	$295.12	$446.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $104.71 / $131.83	Facility	26	$87.10	$104.71	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $107.15 / $134.90	Professional	26	$70.79	$107.15	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $346.74 / $478.63	Professional	TC	$213.80	$346.74	$478.63
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $467.74 / $691.83	Professional		$204.17	$467.74	$691.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $125.89 / $165.96	Professional	26	$52.48	$125.89	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $371.54 / $562.34	Professional	TC	$138.04	$371.54	$562.34
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.14 / $851.14 / $851.14	Facility	26	$851.14	$851.14	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $457.09 / $602.56	Professional		$338.84	$457.09	$602.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $123.03 / $154.88	Professional	26	$95.50	$123.03	$154.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $323.59 / $467.74	Professional	TC	$239.88	$323.59	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $323.59 / $645.65	Professional		$194.98	$323.59	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $74.13 / $165.96	Professional	26	$48.98	$74.13	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $251.19 / $489.78	Professional	TC	$144.54	$251.19	$489.78