Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $190.55 / $218.78	Facility	26	$131.83	$190.55	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $575.44	Professional		$223.87	$309.03	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $100.00 / $263.03	Professional	26	$70.79	$100.00	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $218.78 / $346.74	Professional	TC	$151.36	$218.78	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $371.54 / $794.33	Professional		$239.88	$371.54	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $245.47	Professional	26	$74.13	$114.82	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $251.19 / $549.54	Professional	TC	$158.49	$251.19	$549.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $501.19 / $630.96	Professional		$446.68	$501.19	$630.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $173.78 / $208.93	Professional	26	$151.36	$173.78	$208.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $331.13 / $416.87	Professional	TC	$288.40	$331.13	$416.87
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $190.55 / $218.78	Facility	26	$104.71	$190.55	$218.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $489.78 / $707.95	Professional		$309.03	$489.78	$707.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $169.82 / $239.88	Professional	26	$89.13	$169.82	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $316.23 / $457.09	Professional	TC	$218.78	$316.23	$457.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $162.18 / $165.96	Facility	26	$134.90	$162.18	$165.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $144.54 / $177.83	Professional	26	$109.65	$144.54	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $302.00 / $407.38	Professional	TC	$229.09	$302.00	$407.38
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $134.90	Facility	26	$19.95	$93.33	$134.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $524.81 / $707.95	Professional		$251.19	$524.81	$707.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $165.96 / $239.88	Professional	26	$81.28	$165.96	$239.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $363.08 / $512.86	Professional	TC	$158.49	$363.08	$512.86
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 / $549.54 / $645.65	Professional		$426.58	$549.54	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $173.78 / $223.87	Professional	26	$147.91	$173.78	$223.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $363.08 / $436.52	Professional	TC	$275.42	$363.08	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $331.13 / $724.44	Professional		$213.80	$331.13	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $109.65 / $245.47	Professional	26	$75.86	$109.65	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $218.78 / $478.63	Professional	TC	$138.04	$218.78	$478.63