Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $120.23 / $162.18	Facility	26	$66.07	$120.23	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $602.56	Professional		$169.82	$295.12	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $169.82	Professional	26	$54.95	$83.18	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $338.84	Professional	TC	$114.82	$218.78	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $331.13 / $630.96	Professional		$181.97	$331.13	$630.96
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 $123.03 / $239.88 / $478.63	Professional	TC	$123.03	$239.88	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $380.19 / $478.63	Professional		$331.13	$380.19	$478.63
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 $223.87 / $257.04 / $323.59	Professional	TC	$223.87	$257.04	$323.59
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $104.71 / $162.18	Facility	26	$66.07	$104.71	$162.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $371.54 / $588.84	Professional		$281.84	$371.54	$588.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $177.83	Professional	26	$70.79	$117.49	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $263.03 / $457.09	Professional	TC	$190.55	$263.03	$457.09
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 $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $134.90	Professional	26	$72.44	$107.15	$134.90
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $251.19 / $416.87	Professional	TC	$158.49	$251.19	$416.87
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 $194.98 / $398.11 / $562.34	Professional		$194.98	$398.11	$562.34
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 $123.03 / $275.42 / $457.09	Professional	TC	$123.03	$275.42	$457.09
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 $323.59 / $389.05 / $489.78	Professional		$323.59	$389.05	$489.78
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 $213.80 / $257.04 / $346.74	Professional	TC	$213.80	$257.04	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $562.34	Professional		$165.96	$295.12	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $173.78	Professional	26	$54.95	$77.62	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $218.78 / $380.19	Professional	TC	$109.65	$218.78	$380.19