Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $165.96 / $204.17	Facility	26	$85.11	$165.96	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $776.25	Professional		$223.87	$346.74	$776.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $85.11 / $190.55	Professional	26	$63.10	$85.11	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $426.58	Professional	TC	$147.91	$223.87	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $398.11 / $794.33	Professional		$234.42	$398.11	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $109.65 / $223.87	Professional	26	$69.18	$109.65	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $288.40 / $588.84	Professional	TC	$158.49	$288.40	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $489.78 / $602.56	Professional		$426.58	$489.78	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $162.18 / $194.98	Professional	26	$141.25	$162.18	$194.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $331.13 / $407.38	Professional	TC	$281.84	$331.13	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $154.88 / $204.17	Facility	26	$104.71	$154.88	$204.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $478.63 / $707.95	Professional		$363.08	$478.63	$707.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $147.91 / $223.87	Professional	26	$87.10	$147.91	$223.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $338.84 / $512.86	Professional	TC	$239.88	$338.84	$512.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $141.25 / $154.88	Facility	26	$117.49	$141.25	$154.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $123.03 / $158.49	Professional	26	$87.10	$123.03	$158.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $354.81 / $512.86	Professional	TC	$229.09	$354.81	$512.86
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $524.81 / $707.95	Professional		$245.47	$524.81	$707.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $144.54 / $218.78	Professional	26	$75.86	$144.54	$218.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $380.19 / $575.44	Professional	TC	$158.49	$380.19	$575.44
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 $416.87 / $524.81 / $660.69	Professional		$416.87	$524.81	$660.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $162.18 / $204.17	Professional	26	$125.89	$162.18	$204.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $354.81 / $457.09	Professional	TC	$275.42	$354.81	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $354.81 / $724.44	Professional		$213.80	$354.81	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $91.20 / $218.78	Professional	26	$63.10	$91.20	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $281.84 / $512.86	Professional	TC	$141.25	$281.84	$512.86