Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $120.23 / $144.54	Facility	26	$85.11	$120.23	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $316.23 / $741.31	Professional		$223.87	$316.23	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $74.13 / $186.21	Professional	26	$52.48	$74.13	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $239.88 / $446.68	Professional	TC	$169.82	$239.88	$446.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $380.19 / $776.25	Professional		$234.42	$380.19	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $162.18	Professional	26	$51.29	$81.28	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $295.12 / $602.56	Professional	TC	$181.97	$295.12	$602.56
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 $100.00 / $114.82 / $141.25	Professional	26	$100.00	$114.82	$141.25
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 $75.86 / $104.71 / $144.54	Facility	26	$75.86	$104.71	$144.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $478.63 / $691.83	Professional		$309.03	$478.63	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $162.18	Professional	26	$64.57	$107.15	$162.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $371.54 / $524.81	Professional	TC	$239.88	$371.54	$524.81
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $107.15 / $112.20	Facility	26	$89.13	$107.15	$112.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $257.04 / $257.04	Professional		$234.42	$257.04	$257.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $95.50 / $123.03	Professional	26	$66.07	$95.50	$123.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $316.23 / $446.68	Professional	TC	$204.17	$316.23	$446.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $501.19 / $676.08	Professional		$263.03	$501.19	$676.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $112.20 / $162.18	Professional	26	$53.70	$112.20	$162.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $371.54 / $537.03	Professional	TC	$186.21	$371.54	$537.03
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 $416.87 / $501.19 / $645.65	Professional		$416.87	$501.19	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $114.82 / $147.91	Professional	26	$97.72	$114.82	$147.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $389.05 / $512.86	Professional	TC	$316.23	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $331.13 / $691.83	Professional		$208.93	$331.13	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $158.49	Professional	26	$50.12	$70.79	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $257.04 / $537.03	Professional	TC	$158.49	$257.04	$537.03