Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $123.92 / $274.92	Facility	26	$105.78	$123.92	$274.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.76 / $312.91 / $802.56	Professional		$181.76	$312.91	$802.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $70.14 / $284.00	Professional	26	$50.07	$70.14	$284.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.16 / $255.44 / $419.56	Professional	TC	$134.16	$255.44	$419.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $222.33 / $396.49 / $609.69	Professional		$222.33	$396.49	$609.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.11 / $99.29 / $159.18	Professional	26	$54.11	$99.29	$159.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.78 / $295.08 / $460.93	Professional	TC	$166.78	$295.08	$460.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $401.13 / $455.50 / $551.99	Professional		$401.13	$455.50	$551.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.41 / $120.19 / $140.47	Professional	26	$104.41	$120.19	$140.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $293.51 / $335.79 / $411.51	Professional	TC	$293.51	$335.79	$411.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $334.34 / $399.66 / $638.42	Professional		$334.34	$399.66	$638.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.99 / $105.60 / $166.74	Professional	26	$86.99	$105.60	$166.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $237.50 / $338.26 / $472.12	Professional	TC	$237.50	$338.26	$472.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $81.34 / $107.62 / $111.22	Facility	26	$81.34	$107.62	$111.22
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $254.17 / $254.17 / $254.17	Professional		$254.17	$254.17	$254.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $97.94 / $121.50	Professional	26	$66.73	$97.94	$121.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $194.04 / $305.06 / $391.55	Professional	TC	$194.04	$305.06	$391.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $327.08 / $469.74 / $597.54	Professional		$327.08	$469.74	$597.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.06 / $99.42 / $160.29	Professional	26	$56.06	$99.42	$160.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.78 / $295.08 / $460.93	Professional	TC	$166.78	$295.08	$460.93
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 $375.86 / $470.48 / $595.03	Professional		$375.86	$470.48	$595.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $98.15 / $117.45 / $155.38	Professional	26	$98.15	$117.45	$155.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $277.70 / $355.98 / $439.64	Professional	TC	$277.70	$355.98	$439.64
United Facility/Professional Professional Modifier Low / Median / High Price $191.57 / $297.35 / $645.66	Professional		$191.57	$297.35	$645.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $72.95 / $169.26	Professional	26	$50.31	$72.95	$169.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.88 / $216.75 / $477.51	Professional	TC	$139.88	$216.75	$477.51