Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $131.83 / $162.18	Facility	26	$85.11	$131.83	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $269.15 / $588.84	Professional		$165.96	$269.15	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $85.11 / $218.78	Professional	26	$57.54	$85.11	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $186.21 / $309.03	Professional	TC	$102.33	$186.21	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $660.69	Professional		$165.96	$309.03	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $177.83	Professional	26	$56.23	$91.20	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $223.87 / $489.78	Professional	TC	$107.15	$223.87	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $346.74 / $436.52	Professional		$302.00	$346.74	$436.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $128.82 / $154.88	Professional	26	$112.20	$128.82	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $223.87 / $281.84	Professional	TC	$190.55	$223.87	$281.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $120.23 / $162.18	Facility	26	$85.11	$120.23	$162.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $524.81	Professional		$234.42	$371.54	$524.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $120.23 / $177.83	Professional	26	$67.61	$120.23	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $338.84	Professional	TC	$147.91	$223.87	$338.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $120.23 / $123.03	Facility	26	$100.00	$120.23	$123.03
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Professional		$120.23	$120.23	$120.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $107.15 / $131.83	Professional	26	$72.44	$107.15	$131.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $269.15 / $436.52	Professional	TC	$181.97	$269.15	$436.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $407.38 / $588.84	Professional		$177.83	$407.38	$588.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $123.03 / $177.83	Professional	26	$60.26	$123.03	$177.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $288.40 / $478.63	Professional	TC	$107.15	$288.40	$478.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $398.11 / $512.86	Professional		$295.12	$398.11	$512.86
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $165.96	Professional	26	$109.65	$128.82	$165.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $251.19 / $389.05	Professional	TC	$186.21	$251.19	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $288.40 / $575.44	Professional		$173.78	$288.40	$575.44
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 $117.49 / $213.80 / $407.38	Professional	TC	$117.49	$213.80	$407.38