Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $136.07 / $299.87	Facility	26	$105.78	$136.07	$299.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.01 / $342.37 / $549.54	Professional		$178.01	$342.37	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.58 / $70.01 / $152.33	Professional	26	$52.58	$70.01	$152.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.43 / $285.00 / $397.22	Professional	TC	$125.43	$285.00	$397.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.55 / $468.95 / $675.33	Professional		$218.55	$468.95	$675.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.00 / $108.18 / $175.04	Professional	26	$59.00	$108.18	$175.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.69 / $359.22 / $508.00	Professional	TC	$159.69	$359.22	$508.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $395.06 / $446.06 / $542.46	Professional		$395.06	$446.06	$542.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.90 / $132.16 / $153.18	Professional	26	$113.90	$132.16	$153.18
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 $337.14 / $455.34 / $664.96	Professional		$337.14	$455.34	$664.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.01 / $118.59 / $183.00	Professional	26	$95.01	$118.59	$183.00
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 $88.69 / $117.40 / $121.27	Facility	26	$88.69	$117.40	$121.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $270.14 / $270.14 / $270.14	Professional		$270.14	$270.14	$270.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.36 / $106.20 / $127.61	Professional	26	$72.36	$106.20	$127.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $234.17 / $349.74 / $458.20	Professional	TC	$234.17	$349.74	$458.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $349.20 / $495.45 / $633.97	Professional		$349.20	$495.45	$633.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.15 / $108.18 / $175.04	Professional	26	$62.15	$108.18	$175.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.69 / $358.08 / $517.24	Professional	TC	$159.69	$358.08	$517.24
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 $368.68 / $497.59 / $618.55	Professional		$368.68	$497.59	$618.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $128.06 / $170.55	Professional	26	$107.73	$128.06	$170.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $260.95 / $353.64 / $465.55	Professional	TC	$260.95	$353.64	$465.55
United Facility/Professional Professional Modifier Low / Median / High Price $197.86 / $302.42 / $665.65	Professional		$197.86	$302.42	$665.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.91 / $107.40 / $184.73	Professional	26	$54.91	$107.40	$184.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $242.32 / $482.05	Professional	TC	$142.94	$242.32	$482.05