Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.94 / $129.29 / $261.31	Facility	26	$112.94	$129.29	$261.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.77 / $253.11 / $561.34	Professional		$162.77	$253.11	$561.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.32 / $62.04 / $166.04	Professional	26	$42.32	$62.04	$166.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.44 / $190.18 / $428.60	Professional	TC	$120.44	$190.18	$428.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.69 / $409.94 / $631.37	Professional		$217.69	$409.94	$631.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.43 / $94.62 / $152.41	Professional	26	$51.43	$94.62	$152.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.61 / $313.69 / $476.63	Professional	TC	$164.61	$313.69	$476.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $400.43 / $460.71 / $551.50	Professional		$400.43	$460.71	$551.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.23 / $114.42 / $133.53	Professional	26	$99.23	$114.42	$133.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $298.14 / $346.29 / $418.00	Professional	TC	$298.14	$346.29	$418.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.95 / $419.22 / $644.00	Professional		$323.95	$419.22	$644.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.73 / $109.31 / $158.58	Professional	26	$82.73	$109.31	$158.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $241.25 / $341.98 / $483.78	Professional	TC	$241.25	$341.98	$483.78
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.15 / $102.28 / $105.86	Facility	26	$68.15	$102.28	$105.86
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $178.16 / $178.16 / $178.16	Professional		$178.16	$178.16	$178.16
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.08 / $85.19 / $103.85	Professional	26	$56.08	$85.19	$103.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $248.58 / $292.98 / $311.55	Professional	TC	$248.58	$292.98	$311.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $316.35 / $470.20 / $626.04	Professional		$316.35	$470.20	$626.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.79 / $94.62 / $152.41	Professional	26	$52.79	$94.62	$152.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $170.45 / $316.33 / $483.51	Professional	TC	$170.45	$316.33	$483.51
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $777.03 / $777.03 / $777.03	Facility	26	$777.03	$777.03	$777.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $378.85 / $481.43 / $599.77	Professional		$378.85	$481.43	$599.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.37 / $115.50 / $147.81	Professional	26	$93.37	$115.50	$147.81
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $285.48 / $361.07 / $451.96	Professional	TC	$285.48	$361.07	$451.96
United Facility/Professional Professional Modifier Low / Median / High Price $200.63 / $283.48 / $669.71	Professional		$200.63	$283.48	$669.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.25 / $74.13 / $161.79	Professional	26	$48.25	$74.13	$161.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $152.16 / $211.19 / $505.30	Professional	TC	$152.16	$211.19	$505.30