Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.57 / $121.02 / $268.08	Facility	26	$105.57	$121.02	$268.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.00 / $371.00 / $531.45	Professional		$171.00	$371.00	$531.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.41 / $81.50 / $168.01	Professional	26	$52.41	$81.50	$168.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $285.00 / $430.30	Professional	TC	$119.70	$285.00	$430.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.49 / $459.91 / $645.24	Professional		$202.49	$459.91	$645.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.16 / $110.81 / $156.36	Professional	26	$54.16	$110.81	$156.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.21 / $339.19 / $476.37	Professional	TC	$147.21	$339.19	$476.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $362.13 / $407.16 / $497.55	Professional		$362.13	$407.16	$497.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.82 / $117.21 / $137.00	Professional	26	$101.82	$117.21	$137.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.18 / $291.95 / $360.57	Professional	TC	$257.18	$291.95	$360.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $308.99 / $434.56 / $584.38	Professional		$308.99	$434.56	$584.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.86 / $120.33 / $162.66	Professional	26	$84.86	$120.33	$162.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.15 / $296.45 / $413.77	Professional	TC	$208.15	$296.45	$413.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.39 / $104.95 / $131.99	Facility	26	$87.39	$104.95	$131.99
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $155.88	Professional		$140.29	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.19 / $112.29 / $135.93	Professional	26	$79.19	$112.29	$135.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $233.56 / $323.73 / $508.66	Professional	TC	$233.56	$323.73	$508.66
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $326.31 / $469.06 / $619.71	Professional		$326.31	$469.06	$619.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.27 / $114.85 / $156.36	Professional	26	$55.27	$114.85	$156.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $147.21 / $334.57 / $476.37	Professional	TC	$147.21	$334.57	$476.37
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 $336.36 / $456.20 / $609.47	Professional		$336.36	$456.20	$609.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.76 / $121.77 / $153.44	Professional	26	$95.76	$121.77	$153.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $240.60 / $325.74 / $464.82	Professional	TC	$240.60	$325.74	$464.82
United Facility/Professional Professional Modifier Low / Median / High Price $192.95 / $342.44 / $623.83	Professional		$192.95	$342.44	$623.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.08 / $74.09 / $165.37	Professional	26	$49.08	$74.09	$165.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.87 / $224.02 / $476.97	Professional	TC	$143.87	$224.02	$476.97