Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.61 / $128.52 / $283.44	Facility	26	$111.61	$128.52	$283.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $249.22 / $475.00 / $718.21	Professional		$249.22	$475.00	$718.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $137.97 / $338.90	Professional	26	$62.50	$137.97	$338.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $178.06 / $335.00 / $605.59	Professional	TC	$178.06	$335.00	$605.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.32 / $562.22 / $846.73	Professional		$239.32	$562.22	$846.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.77 / $102.30 / $165.21	Professional	26	$55.77	$102.30	$165.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.06 / $439.63 / $686.38	Professional	TC	$182.06	$439.63	$686.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $432.66 / $487.83 / $595.79	Professional		$432.66	$487.83	$595.79
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.65 / $125.00 / $144.79	Professional	26	$107.65	$125.00	$144.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.70 / $365.18 / $451.00	Professional	TC	$321.70	$365.18	$451.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $360.72 / $525.16 / $873.18	Professional		$360.72	$525.16	$873.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.66 / $111.89 / $172.83	Professional	26	$89.66	$111.89	$172.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.45 / $370.95 / $733.95	Professional	TC	$260.45	$370.95	$733.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $84.28 / $110.96 / $115.24	Facility	26	$84.28	$110.96	$115.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.23 / $102.51 / $121.41	Professional	26	$72.23	$102.51	$121.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.56 / $570.35 / $849.01	Professional	TC	$313.56	$570.35	$849.01
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.84 / $64.84 / $64.84	Facility	26	$64.84	$64.84	$64.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $382.88 / $562.59 / $821.84	Professional		$382.88	$562.59	$821.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.79 / $102.45 / $165.21	Professional	26	$58.79	$102.45	$165.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $183.91 / $430.87 / $686.38	Professional	TC	$183.91	$430.87	$686.38
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $402.19 / $545.63 / $819.77	Professional		$402.19	$545.63	$819.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.75 / $120.98 / $161.07	Professional	26	$101.75	$120.98	$161.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $300.45 / $407.79 / $621.44	Professional	TC	$300.45	$407.79	$621.44
United Facility/Professional Professional Modifier Low / Median / High Price $211.67 / $414.00 / $744.10	Professional		$211.67	$414.00	$744.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.15 / $75.20 / $188.11	Professional	26	$52.15	$75.20	$188.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.52 / $312.00 / $555.45	Professional	TC	$159.52	$312.00	$555.45