Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $128.82 / $154.88	Facility	26	$93.33	$128.82	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $562.34	Professional		$169.82	$281.84	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $181.97	Professional	26	$52.48	$77.62	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $331.13	Professional	TC	$114.82	$218.78	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $338.84 / $645.65	Professional		$177.83	$338.84	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $169.82	Professional	26	$53.70	$85.11	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $239.88 / $489.78	Professional	TC	$123.03	$239.88	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $371.54 / $467.74	Professional		$323.59	$371.54	$467.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $147.91	Professional	26	$107.15	$123.03	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $251.19 / $316.23	Professional	TC	$218.78	$251.19	$316.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $154.88	Facility	26	$154.88	$154.88	$154.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $575.44	Professional		$275.42	$398.11	$575.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $169.82	Professional	26	$77.62	$114.82	$169.82
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 $93.33 / $112.20 / $117.49	Facility	26	$93.33	$112.20	$117.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $323.59 / $323.59	Professional		$323.59	$323.59	$323.59
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $128.82	Professional	26	$69.18	$102.33	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $446.68	Professional	TC	$186.21	$288.40	$446.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $416.87 / $588.84	Professional		$186.21	$416.87	$588.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $117.49 / $169.82	Professional	26	$56.23	$117.49	$169.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $309.03 / $478.63	Professional	TC	$123.03	$309.03	$478.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	26	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $524.81	Professional		$316.23	$416.87	$524.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $123.03 / $158.49	Professional	26	$102.33	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $281.84 / $380.19	Professional	TC	$208.93	$281.84	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $575.44	Professional		$169.82	$295.12	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $165.96	Professional	26	$52.48	$74.13	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $229.09 / $398.11	Professional	TC	$114.82	$229.09	$398.11