Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $112.20 / $131.83	Facility	26	$72.44	$112.20	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $245.47 / $616.60	Professional		$177.83	$245.47	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $54.95 / $131.83	Professional	26	$41.69	$54.95	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $177.83 / $363.08	Professional	TC	$128.82	$177.83	$363.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $316.23 / $691.83	Professional		$204.17	$316.23	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $72.44 / $154.88	Professional	26	$46.77	$72.44	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $234.42 / $501.19	Professional	TC	$154.88	$234.42	$501.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $436.52 / $549.54	Professional		$380.19	$436.52	$549.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $109.65 / $134.90	Professional	26	$95.50	$109.65	$134.90
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 Professional Modifier Low / Median / High Price $323.59 / $426.58 / $630.96	Professional		$323.59	$426.58	$630.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $107.15 / $154.88	Professional	26	$83.18	$107.15	$154.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $323.59 / $467.74	Professional	TC	$245.47	$323.59	$467.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $102.33 / $104.71	Facility	26	$85.11	$102.33	$104.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Professional		$134.90	$134.90	$134.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $85.11 / $104.71	Professional	26	$61.66	$85.11	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $295.12 / $331.13	Professional	TC	$251.19	$295.12	$331.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $446.68 / $645.65	Professional		$223.87	$446.68	$645.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $100.00 / $154.88	Professional	26	$51.29	$100.00	$154.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $323.59 / $501.19	Professional	TC	$162.18	$323.59	$501.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $457.09 / $575.44	Professional		$380.19	$457.09	$575.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $109.65 / $141.25	Professional	26	$93.33	$109.65	$141.25
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $354.81 / $436.52	Professional	TC	$288.40	$354.81	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $281.84 / $630.96	Professional		$199.53	$281.84	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $69.18 / $158.49	Professional	26	$47.86	$69.18	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $213.80 / $478.63	Professional	TC	$151.36	$213.80	$478.63