Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $123.03 / $204.17	Facility	26	$85.11	$123.03	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $524.81	Professional		$162.18	$275.42	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $218.78	Professional	26	$52.48	$83.18	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $194.98 / $331.13	Professional	TC	$104.71	$194.98	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $616.60	Professional		$162.18	$309.03	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $162.18	Professional	26	$52.48	$83.18	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $213.80 / $478.63	Professional	TC	$107.15	$213.80	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $331.13 / $416.87	Professional		$295.12	$331.13	$416.87
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 $194.98 / $223.87 / $281.84	Professional	TC	$194.98	$223.87	$281.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $107.15 / $204.17	Facility	26	$85.11	$107.15	$204.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $524.81	Professional		$251.19	$346.74	$524.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $109.65 / $158.49	Professional	26	$66.07	$109.65	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $229.09 / $371.54	Professional	TC	$165.96	$229.09	$371.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $104.71 / $120.23	Facility	26	$87.10	$104.71	$120.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $229.09	Professional		$165.96	$165.96	$229.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $123.03	Professional	26	$67.61	$97.72	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $426.58	Professional	TC	$131.83	$218.78	$426.58
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 $169.82 / $354.81 / $562.34	Professional		$169.82	$354.81	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $112.20 / $158.49	Professional	26	$52.48	$112.20	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $245.47 / $478.63	Professional	TC	$107.15	$245.47	$478.63
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 $281.84 / $346.74 / $467.74	Professional		$281.84	$346.74	$467.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $112.20 / $144.54	Professional	26	$95.50	$112.20	$144.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $229.09 / $331.13	Professional	TC	$186.21	$229.09	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $281.84 / $501.19	Professional		$144.54	$281.84	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $72.44 / $154.88	Professional	26	$48.98	$72.44	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $199.53 / $331.13	Professional	TC	$95.50	$199.53	$331.13