Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.57 / $214.46 / $283.44	Facility	26	$122.57	$214.46	$283.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $475.00 / $645.24	Professional		$250.00	$475.00	$645.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $120.77 / $322.00	Professional	26	$62.50	$120.77	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $499.00	Professional	TC	$187.50	$335.00	$499.00
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 $252.54 / $568.63 / $861.06	Professional		$252.54	$568.63	$861.06
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 $195.28 / $461.50 / $720.87	Professional	TC	$195.28	$461.50	$720.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $457.10 / $514.45 / $630.05	Professional		$457.10	$514.45	$630.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.65 / $124.28 / $144.79	Professional	26	$107.65	$124.28	$144.79
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $346.14 / $392.93 / $485.27	Professional	TC	$346.14	$392.93	$485.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $369.86 / $526.78 / $854.28	Professional		$369.86	$526.78	$854.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.66 / $113.60 / $171.81	Professional	26	$89.66	$113.60	$171.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $280.20 / $399.08 / $733.95	Professional	TC	$280.20	$399.08	$733.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $83.79 / $110.96 / $114.57	Facility	26	$83.79	$110.96	$114.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.73 / $104.59 / $119.07	Professional	26	$68.73	$104.59	$119.07
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $326.61 / $535.53 / $828.82	Professional	TC	$326.61	$535.53	$828.82
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 $401.45 / $580.75 / $818.80	Professional		$401.45	$580.75	$818.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.42 / $102.45 / $165.21	Professional	26	$58.42	$102.45	$165.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $197.91 / $454.40 / $720.87	Professional	TC	$197.91	$454.40	$720.87
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 $424.94 / $571.52 / $822.89	Professional		$424.94	$571.52	$822.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.15 / $120.98 / $160.13	Professional	26	$101.15	$120.98	$160.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $323.79 / $437.33 / $659.97	Professional	TC	$323.79	$437.33	$659.97
United Facility/Professional Professional Modifier Low / Median / High Price $221.18 / $423.53 / $755.37	Professional		$221.18	$423.53	$755.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.93 / $72.97 / $175.09	Professional	26	$51.93	$72.97	$175.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.03 / $369.46 / $575.57	Professional	TC	$169.03	$369.46	$575.57