Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $133.33 / $295.42	Facility	26	$105.78	$133.33	$295.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.60 / $371.00 / $753.74	Professional		$181.60	$371.00	$753.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.99 / $76.01 / $247.37	Professional	26	$52.99	$76.01	$247.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.71 / $285.00 / $395.38	Professional	TC	$125.71	$285.00	$395.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.92 / $418.65 / $668.23	Professional		$216.92	$418.65	$668.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.68 / $115.11 / $172.09	Professional	26	$59.68	$115.11	$172.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.24 / $304.00 / $500.56	Professional	TC	$157.24	$304.00	$500.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $393.72 / $444.85 / $540.78	Professional		$393.72	$444.85	$540.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.59 / $130.22 / $151.49	Professional	26	$112.59	$130.22	$151.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $277.66 / $315.20 / $389.28	Professional	TC	$277.66	$315.20	$389.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $336.01 / $453.81 / $673.28	Professional		$336.01	$453.81	$673.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.93 / $124.15 / $178.92	Professional	26	$93.93	$124.15	$178.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $224.70 / $320.02 / $577.22	Professional	TC	$224.70	$320.02	$577.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $96.25 / $116.06 / $131.99	Facility	26	$96.25	$116.06	$131.99
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $78.80 / $112.19 / $138.44	Professional	26	$78.80	$112.19	$138.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $231.60 / $329.74 / $527.82	Professional	TC	$231.60	$329.74	$527.82
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $331.61 / $490.77 / $616.64	Professional		$331.61	$490.77	$616.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.88 / $116.65 / $172.09	Professional	26	$60.88	$116.65	$172.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.33 / $298.75 / $485.86	Professional	TC	$159.33	$298.75	$485.86
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 $365.68 / $493.66 / $626.23	Professional		$365.68	$493.66	$626.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $105.34 / $128.10 / $166.76	Professional	26	$105.34	$128.10	$166.76
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $260.35 / $351.58 / $463.71	Professional	TC	$260.35	$351.58	$463.71
United Facility/Professional Professional Modifier Low / Median / High Price $200.32 / $306.37 / $674.96	Professional		$200.32	$306.37	$674.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.81 / $84.00 / $194.74	Professional	26	$59.81	$84.00	$194.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.51 / $238.17 / $473.42	Professional	TC	$140.51	$238.17	$473.42