Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $144.54 / $177.83	Facility	26	$85.11	$144.54	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $398.11 / $954.99	Professional		$251.19	$398.11	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $91.20 / $186.21	Professional	26	$61.66	$91.20	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $275.42 / $524.81	Professional	TC	$169.82	$275.42	$524.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $912.01	Professional		$275.42	$457.09	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $97.72 / $194.98	Professional	26	$61.66	$97.72	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $363.08 / $724.44	Professional	TC	$208.93	$363.08	$724.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $575.44 / $724.44	Professional		$501.19	$575.44	$724.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $169.82	Professional	26	$120.23	$138.04	$169.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $436.52 / $549.54	Professional	TC	$380.19	$436.52	$549.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $120.23 / $177.83	Facility	26	$85.11	$120.23	$177.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $549.54 / $831.76	Professional		$323.59	$549.54	$831.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $128.82 / $194.98	Professional	26	$77.62	$128.82	$194.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $426.58 / $630.96	Professional	TC	$257.04	$426.58	$630.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $128.82 / $134.90	Facility	26	$107.15	$128.82	$134.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Professional		$257.04	$257.04	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $120.23 / $147.91	Professional	26	$83.18	$120.23	$147.91
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $630.96	Professional	TC	$245.47	$363.08	$630.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $588.84 / $831.76	Professional		$295.12	$588.84	$831.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $134.90 / $194.98	Professional	26	$64.57	$134.90	$194.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $426.58 / $724.44	Professional	TC	$208.93	$426.58	$724.44
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 $478.63 / $575.44 / $758.58	Professional		$478.63	$575.44	$758.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $141.25 / $181.97	Professional	26	$117.49	$141.25	$181.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $436.52 / $588.84	Professional	TC	$363.08	$436.52	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $407.38 / $812.83	Professional		$239.88	$407.38	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $87.10 / $199.53	Professional	26	$60.26	$87.10	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $630.96	Professional	TC	$177.83	$338.84	$630.96