Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $124.11 / $274.92	Facility	26	$105.78	$124.11	$274.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.28 / $307.42 / $521.58	Professional		$153.28	$307.42	$521.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $83.57 / $288.00	Professional	26	$50.07	$83.57	$288.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.20 / $254.24 / $433.75	Professional	TC	$114.20	$254.24	$433.75
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 $183.77 / $389.74 / $567.86	Professional		$183.77	$389.74	$567.86
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 $129.60 / $292.07 / $405.57	Professional	TC	$129.60	$292.07	$405.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $334.41 / $375.61 / $458.42	Professional		$334.41	$375.61	$458.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.41 / $120.41 / $140.47	Professional	26	$104.41	$120.41	$140.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $226.79 / $257.44 / $317.94	Professional	TC	$226.79	$257.44	$317.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $278.80 / $385.40 / $537.91	Professional		$278.80	$385.40	$537.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.99 / $108.54 / $166.74	Professional	26	$86.99	$108.54	$166.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.60 / $261.48 / $385.64	Professional	TC	$183.60	$261.48	$385.64
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 $140.29 / $140.29 / $198.80	Professional		$140.29	$140.29	$198.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $98.89 / $117.03	Professional	26	$66.73	$98.89	$117.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $201.40 / $262.89 / $371.35	Professional	TC	$201.40	$262.89	$371.35
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 $295.31 / $415.95 / $530.66	Professional		$295.31	$415.95	$530.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.41 / $99.42 / $160.29	Professional	26	$56.41	$99.42	$160.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $129.60 / $291.49 / $419.86	Professional	TC	$129.60	$291.49	$419.86
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 $310.02 / $419.02 / $517.51	Professional		$310.02	$419.02	$517.51
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 $211.87 / $287.18 / $375.77	Professional	TC	$211.87	$287.18	$375.77
United Facility/Professional Professional Modifier Low / Median / High Price $167.19 / $274.43 / $563.32	Professional		$167.19	$274.43	$563.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.31 / $65.11 / $167.94	Professional	26	$50.31	$65.11	$167.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $188.44 / $392.93	Professional	TC	$116.88	$188.44	$392.93