Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.04 / $95.40 / $212.26	Facility	26	$72.04	$95.40	$212.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $149.00 / $695.00	Professional		$109.14	$149.00	$695.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.91 / $48.39 / $114.00	Professional	26	$29.91	$48.39	$114.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.97 / $98.08 / $247.33	Professional	TC	$75.97	$98.08	$247.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.64 / $48.64 / $48.64	Facility	26	$48.64	$48.64	$48.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.36 / $249.41 / $395.16	Professional		$135.36	$249.41	$395.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $71.02 / $117.02	Professional	26	$38.01	$71.02	$117.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.88 / $182.90 / $286.16	Professional	TC	$95.88	$182.90	$286.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.89 / $320.20 / $370.30	Professional		$269.89	$320.20	$370.30
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.68 / $96.39 / $108.52	Professional	26	$80.68	$96.39	$108.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.73 / $222.96 / $261.81	Professional	TC	$186.73	$222.96	$261.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $191.50 / $231.53 / $431.04	Professional		$191.50	$231.53	$431.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.36 / $82.34 / $128.10	Professional	26	$63.36	$82.34	$128.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.19 / $188.20 / $300.25	Professional	TC	$145.19	$188.20	$300.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $51.07 / $71.81 / $85.68	Facility	26	$51.07	$71.81	$85.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $45.14 / $58.14 / $86.51	Professional	26	$45.14	$58.14	$86.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $108.94 / $154.47 / $202.55	Professional	TC	$108.94	$154.47	$202.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $48.64 / $48.64 / $48.64	Facility	26	$48.64	$48.64	$48.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $211.22 / $298.33 / $404.49	Professional		$211.22	$298.33	$404.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.48 / $77.69 / $118.27	Professional	26	$49.48	$77.69	$118.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $132.06 / $202.16 / $286.16	Professional	TC	$132.06	$202.16	$286.16
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $236.16 / $289.82 / $394.48	Professional		$236.16	$289.82	$394.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.89 / $86.31 / $119.39	Professional	26	$60.89	$86.31	$119.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $174.46 / $202.35 / $277.27	Professional	TC	$174.46	$202.35	$277.27
United Facility/Professional Professional Modifier Low / Median / High Price $129.00 / $145.41 / $439.26	Professional		$129.00	$145.41	$439.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.53 / $46.19 / $131.06	Professional	26	$35.53	$46.19	$131.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.71 / $109.46 / $270.82	Professional	TC	$92.71	$109.46	$270.82