Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $141.25 / $173.78	Facility	26	$85.11	$141.25	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $316.23 / $912.01	Professional		$199.53	$316.23	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $102.33 / $295.12	Professional	26	$61.66	$102.33	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $407.38	Professional	TC	$123.03	$218.78	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $331.13 / $660.69	Professional		$194.98	$331.13	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $97.72 / $190.55	Professional	26	$61.66	$97.72	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $234.42 / $467.74	Professional	TC	$128.82	$234.42	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $407.38 / $501.19	Professional		$354.81	$407.38	$501.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $165.96	Professional	26	$120.23	$138.04	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $269.15 / $338.84	Professional	TC	$234.42	$269.15	$338.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $131.83 / $257.04	Facility	26	$85.11	$131.83	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $398.11 / $588.84	Professional		$295.12	$398.11	$588.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $204.17	Professional	26	$70.79	$128.82	$204.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $275.42 / $416.87	Professional	TC	$190.55	$275.42	$416.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $128.82 / $131.83	Facility	26	$107.15	$128.82	$131.83
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 $79.43 / $117.49 / $138.04	Professional	26	$79.43	$117.49	$138.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $281.84 / $416.87	Professional	TC	$190.55	$281.84	$416.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $74.13 / $107.15	Facility	26	$15.85	$74.13	$107.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $436.52 / $588.84	Professional		$204.17	$436.52	$588.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $134.90 / $190.55	Professional	26	$64.57	$134.90	$190.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $309.03 / $467.74	Professional	TC	$128.82	$309.03	$467.74
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 $346.74 / $426.58 / $549.54	Professional		$346.74	$426.58	$549.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $138.04 / $177.83	Professional	26	$117.49	$138.04	$177.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $288.40 / $371.54	Professional	TC	$223.87	$288.40	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $295.12 / $602.56	Professional		$173.78	$295.12	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $190.55	Professional	26	$60.26	$83.18	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $223.87 / $416.87	Professional	TC	$114.82	$223.87	$416.87