Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $131.83 / $151.36	Facility	26	$91.20	$131.83	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $251.19 / $616.60	Professional		$138.04	$251.19	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $77.62 / $141.25	Professional	26	$53.70	$77.62	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $158.49 / $281.84	Professional	TC	$83.18	$158.49	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $263.03 / $501.19	Professional		$144.54	$263.03	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $83.18 / $165.96	Professional	26	$52.48	$83.18	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $173.78 / $346.74	Professional	TC	$89.13	$173.78	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $302.00 / $371.54	Professional		$263.03	$302.00	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $120.23 / $144.54	Professional	26	$104.71	$120.23	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $181.97 / $229.09	Professional	TC	$158.49	$181.97	$229.09
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $131.83 / $151.36	Facility	26	$102.33	$131.83	$151.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $467.74	Professional		$204.17	$295.12	$467.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $109.65 / $165.96	Professional	26	$67.61	$109.65	$165.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $190.55 / $363.08	Professional	TC	$134.90	$190.55	$363.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $114.82	Facility	26	$91.20	$109.65	$114.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $117.49	Professional	26	$67.61	$97.72	$117.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $162.18 / $316.23	Professional	TC	$102.33	$162.18	$316.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $309.03 / $446.68	Professional		$151.36	$309.03	$446.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $114.82 / $165.96	Professional	26	$54.95	$114.82	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $199.53 / $354.81	Professional	TC	$89.13	$199.53	$354.81
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 $251.19 / $302.00 / $407.38	Professional		$251.19	$302.00	$407.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $120.23 / $154.88	Professional	26	$100.00	$120.23	$154.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $181.97 / $239.88	Professional	TC	$151.36	$181.97	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $239.88 / $446.68	Professional		$128.82	$239.88	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $169.82	Professional	26	$51.29	$74.13	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $162.18 / $275.42	Professional	TC	$77.62	$162.18	$275.42