Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $131.83 / $257.04	Facility	26	$95.50	$131.83	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $323.59 / $616.60	Professional		$204.17	$323.59	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $169.82	Professional	26	$54.95	$75.86	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $229.09 / $407.38	Professional	TC	$141.25	$229.09	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $398.11 / $776.25	Professional		$208.93	$398.11	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $190.55	Professional	26	$58.88	$91.20	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $302.00 / $616.60	Professional	TC	$151.36	$302.00	$616.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $436.52 / $537.03	Professional		$380.19	$436.52	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $151.36	Professional	26	$109.65	$125.89	$151.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $309.03 / $389.05	Professional	TC	$269.15	$309.03	$389.05
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $117.49 / $257.04	Facility	26	$102.33	$117.49	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $457.09 / $691.83	Professional		$323.59	$457.09	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $120.23 / $173.78	Professional	26	$72.44	$120.23	$173.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $323.59 / $575.44	Professional	TC	$229.09	$323.59	$575.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $114.82 / $131.83	Facility	26	$95.50	$114.82	$131.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $269.15	Professional		$165.96	$165.96	$269.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $144.54	Professional	26	$79.43	$114.82	$144.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $354.81 / $537.03	Professional	TC	$234.42	$354.81	$537.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $489.78 / $707.95	Professional		$218.78	$489.78	$707.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $131.83 / $186.21	Professional	26	$58.88	$131.83	$186.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $371.54 / $588.84	Professional	TC	$151.36	$371.54	$588.84
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 $363.08 / $478.63 / $630.96	Professional		$363.08	$478.63	$630.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $128.82 / $162.18	Professional	26	$104.71	$128.82	$162.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $338.84 / $457.09	Professional	TC	$263.03	$338.84	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $691.83	Professional		$199.53	$371.54	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $181.97	Professional	26	$58.88	$81.28	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $281.84 / $489.78	Professional	TC	$141.25	$281.84	$489.78