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 / $186.21	Facility	26	$85.11	$131.83	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $281.84 / $501.19	Professional		$177.83	$281.84	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $229.09	Professional	26	$54.95	$75.86	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $218.78 / $331.13	Professional	TC	$120.23	$218.78	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $338.84 / $645.65	Professional		$181.97	$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 / $257.04 / $316.23	Professional	TC	$218.78	$257.04	$316.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $114.82 / $186.21	Facility	26	$85.11	$114.82	$186.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $398.11 / $575.44	Professional		$288.40	$398.11	$575.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $169.82	Professional	26	$74.13	$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 $95.50 / $112.20 / $117.49	Facility	26	$95.50	$112.20	$117.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $128.82	Professional	26	$70.79	$104.71	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $398.11	Professional	TC	$186.21	$302.00	$398.11
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 $190.55 / $416.87 / $588.84	Professional		$190.55	$416.87	$588.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $117.49 / $169.82	Professional	26	$57.54	$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 $851.14 / $851.14 / $851.14	Facility	26	$851.14	$851.14	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $524.81	Professional		$316.23	$426.58	$524.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $123.03 / $158.49	Professional	26	$104.71	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $288.40 / $380.19	Professional	TC	$213.80	$288.40	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $295.12 / $588.84	Professional		$169.82	$295.12	$588.84
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 $117.49 / $234.42 / $407.38	Professional	TC	$117.49	$234.42	$407.38