Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $107.15 / $223.87	Facility	26	$75.86	$107.15	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $245.47 / $676.08	Professional		$131.83	$245.47	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $151.36	Professional	26	$43.65	$63.10	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $169.82 / $302.00	Professional	TC	$85.11	$169.82	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $524.81	Professional		$138.04	$263.03	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $69.18 / $138.04	Professional	26	$44.67	$69.18	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $186.21 / $389.05	Professional	TC	$91.20	$186.21	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $288.40 / $354.81	Professional		$251.19	$288.40	$354.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $120.23	Professional	26	$87.10	$100.00	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $186.21 / $234.42	Professional	TC	$162.18	$186.21	$234.42
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $102.33 / $223.87	Facility	26	$85.11	$102.33	$223.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $489.78	Professional		$181.97	$302.00	$489.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $97.72 / $141.25	Professional	26	$50.12	$97.72	$141.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $194.98 / $389.05	Professional	TC	$138.04	$194.98	$389.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $114.82 / $114.82	Professional		$93.33	$114.82	$114.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $83.18 / $104.71	Professional	26	$57.54	$83.18	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $213.80 / $346.74	Professional	TC	$147.91	$213.80	$346.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $323.59 / $478.63	Professional		$144.54	$323.59	$478.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $97.72 / $138.04	Professional	26	$46.77	$97.72	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $239.88 / $380.19	Professional	TC	$91.20	$239.88	$380.19
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 $239.88 / $323.59 / $416.87	Professional		$239.88	$323.59	$416.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $100.00 / $128.82	Professional	26	$85.11	$100.00	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $295.12	Professional	TC	$154.88	$208.93	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $251.19 / $457.09	Professional		$134.90	$251.19	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $134.90	Professional	26	$43.65	$63.10	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $181.97 / $309.03	Professional	TC	$91.20	$181.97	$309.03