Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $128.82 / $213.80	Facility	26	$91.20	$128.82	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $724.44	Professional		$251.19	$478.63	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $109.65 / $181.97	Professional	26	$57.54	$109.65	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $338.84 / $537.03	Professional	TC	$186.21	$338.84	$537.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $501.19 / $1,047.13	Professional		$245.47	$501.19	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $169.82	Professional	26	$52.48	$83.18	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $407.38 / $933.25	Professional	TC	$186.21	$407.38	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $501.19 / $630.96	Professional		$436.52	$501.19	$630.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $120.23 / $144.54	Professional	26	$104.71	$120.23	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $389.05 / $489.78	Professional	TC	$331.13	$389.05	$489.78
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $537.03 / $870.96	Professional		$398.11	$537.03	$870.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $165.96	Professional	26	$93.33	$117.49	$165.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $398.11 / $724.44	Professional	TC	$288.40	$398.11	$724.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $112.20 / $114.82	Facility	26	$93.33	$112.20	$114.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $354.81	Professional		$257.04	$257.04	$354.81
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $120.23	Professional	26	$69.18	$100.00	$120.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $478.63 / $831.76	Professional	TC	$275.42	$478.63	$831.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $588.84 / $954.99	Professional		$257.04	$588.84	$954.99
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $114.82 / $165.96	Professional	26	$56.23	$114.82	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $489.78 / $1,000.00	Professional	TC	$186.21	$489.78	$1,000.00
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 / $562.34 / $831.76	Professional		$426.58	$562.34	$831.76
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $154.88	Professional	26	$102.33	$120.23	$154.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $436.52 / $660.69	Professional	TC	$323.59	$436.52	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $436.52 / $812.83	Professional		$218.78	$436.52	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $70.79 / $158.49	Professional	26	$52.48	$70.79	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $363.08 / $660.69	Professional	TC	$169.82	$363.08	$660.69