Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $95.50 / $107.15	Facility	26	$69.18	$95.50	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $144.54 / $389.05	Professional		$109.65	$144.54	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $52.48 / $117.49	Professional	26	$30.90	$52.48	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $100.00 / $223.87	Professional	TC	$75.86	$100.00	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $257.04 / $398.11	Professional		$120.23	$257.04	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $72.44 / $120.23	Professional	26	$37.15	$72.44	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $181.97 / $288.40	Professional	TC	$85.11	$181.97	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $295.12 / $371.54	Professional		$257.04	$295.12	$371.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $89.13 / $109.65	Professional	26	$77.62	$89.13	$109.65
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $208.93 / $263.03	Professional	TC	$177.83	$208.93	$263.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $85.11 / $107.15	Facility	26	$58.88	$85.11	$107.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $407.38	Professional		$144.54	$245.47	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $85.11 / $123.03	Professional	26	$43.65	$85.11	$123.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $186.21 / $281.84	Professional	TC	$97.72	$186.21	$281.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $69.18 / $85.11	Facility	26	$56.23	$69.18	$85.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $81.28	Professional	26	$44.67	$58.88	$81.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $154.88 / $190.55	Professional	TC	$109.65	$154.88	$190.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $281.84 / $407.38	Professional		$213.80	$281.84	$407.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $74.13 / $120.23	Professional	26	$50.12	$74.13	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $194.98 / $281.84	Professional	TC	$125.89	$194.98	$281.84
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 $234.42 / $288.40 / $371.54	Professional		$234.42	$288.40	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $114.82	Professional	26	$60.26	$83.18	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $204.17 / $263.03	Professional	TC	$173.78	$204.17	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $151.36 / $363.08	Professional		$120.23	$151.36	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $47.86 / $112.20	Professional	26	$35.48	$47.86	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $107.15 / $257.04	Professional	TC	$89.13	$107.15	$257.04