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 $165.96 / $275.42 / $588.84	Professional		$165.96	$275.42	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $154.88	Professional	26	$48.98	$70.79	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $416.87	Professional	TC	$144.54	$218.78	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $363.08 / $691.83	Professional		$204.17	$363.08	$691.83
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 $158.49 / $275.42 / $537.03	Professional	TC	$158.49	$275.42	$537.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $446.68 / $549.54	Professional		$389.05	$446.68	$549.54
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 $281.84 / $331.13 / $407.38	Professional	TC	$281.84	$331.13	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $125.89 / $144.54	Facility	26	$104.71	$125.89	$144.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $426.58 / $602.56	Professional		$295.12	$426.58	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $107.15 / $162.18	Professional	26	$67.61	$107.15	$162.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $316.23 / $467.74	Professional	TC	$234.42	$316.23	$467.74
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 $251.19 / $251.19 / $251.19	Professional		$251.19	$251.19	$251.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $120.23	Professional	26	$66.07	$100.00	$120.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $416.87	Professional	TC	$186.21	$302.00	$416.87
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 $229.09 / $457.09 / $616.60	Professional		$229.09	$457.09	$616.60
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 $158.49 / $338.84 / $501.19	Professional	TC	$158.49	$338.84	$501.19
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 $380.19 / $446.68 / $575.44	Professional		$380.19	$446.68	$575.44
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 $275.42 / $331.13 / $426.58	Professional	TC	$275.42	$331.13	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $616.60	Professional		$190.55	$302.00	$616.60
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 $141.25 / $223.87 / $467.74	Professional	TC	$141.25	$223.87	$467.74