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 / $173.78	Facility	26	$85.11	$128.82	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $891.25	Professional		$239.88	$346.74	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $83.18 / $208.93	Professional	26	$57.54	$83.18	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $257.04 / $457.09	Professional	TC	$169.82	$257.04	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $398.11 / $794.33	Professional		$239.88	$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 $181.97 / $295.12 / $602.56	Professional	TC	$181.97	$295.12	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $512.86 / $630.96	Professional		$446.68	$512.86	$630.96
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 $331.13 / $389.05 / $478.63	Professional	TC	$331.13	$389.05	$478.63
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $120.23 / $173.78	Facility	26	$85.11	$120.23	$173.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $489.78 / $707.95	Professional		$316.23	$489.78	$707.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $117.49 / $177.83	Professional	26	$72.44	$117.49	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $524.81	Professional	TC	$251.19	$371.54	$524.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $117.49 / $123.03	Facility	26	$97.72	$117.49	$123.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $128.82	Professional	26	$72.44	$107.15	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $316.23 / $467.74	Professional	TC	$208.93	$316.23	$467.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $512.86 / $691.83	Professional		$263.03	$512.86	$691.83
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 $186.21 / $371.54 / $562.34	Professional	TC	$186.21	$371.54	$562.34
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 $426.58 / $512.86 / $645.65	Professional		$426.58	$512.86	$645.65
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 $316.23 / $389.05 / $512.86	Professional	TC	$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $338.84 / $707.95	Professional		$208.93	$338.84	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $181.97	Professional	26	$54.95	$79.43	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $269.15 / $537.03	Professional	TC	$158.49	$269.15	$537.03