Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $128.82 / $151.36	Facility	26	$85.11	$128.82	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $302.00 / $512.86	Professional		$194.98	$302.00	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $67.61 / $134.90	Professional	26	$52.48	$67.61	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $218.78 / $371.54	Professional	TC	$134.90	$218.78	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $398.11 / $794.33	Professional		$208.93	$398.11	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $89.13 / $177.83	Professional	26	$56.23	$89.13	$177.83
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 / $154.88	Professional	26	$109.65	$125.89	$154.88
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 $104.71 / $104.71 / $104.71	Facility	26	$104.71	$104.71	$104.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $691.83	Professional		$331.13	$467.74	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $120.23 / $177.83	Professional	26	$83.18	$120.23	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $323.59 / $575.44	Professional	TC	$234.42	$323.59	$575.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $117.49 / $120.23	Facility	26	$97.72	$117.49	$120.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $114.82 / $131.83	Professional	26	$72.44	$114.82	$131.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $363.08 / $537.03	Professional	TC	$251.19	$363.08	$537.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $489.78 / $707.95	Professional		$223.87	$489.78	$707.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $123.03 / $177.83	Professional	26	$58.88	$123.03	$177.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $380.19 / $602.56	Professional	TC	$151.36	$380.19	$602.56
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 $371.54 / $489.78 / $616.60	Professional		$371.54	$489.78	$616.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $128.82 / $165.96	Professional	26	$107.15	$128.82	$165.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $467.74	Professional	TC	$263.03	$354.81	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $363.08 / $676.08	Professional		$199.53	$363.08	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $173.78	Professional	26	$54.95	$77.62	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $288.40 / $501.19	Professional	TC	$144.54	$288.40	$501.19