Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $102.33 / $151.36	Facility	26	$66.07	$102.33	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $194.98 / $724.44	Professional		$131.83	$194.98	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $56.23 / $131.83	Professional	26	$41.69	$56.23	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $128.82 / $309.03	Professional	TC	$91.20	$128.82	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $309.03 / $467.74	Professional		$173.78	$309.03	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $87.10 / $138.04	Professional	26	$51.29	$87.10	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $223.87 / $331.13	Professional	TC	$125.89	$223.87	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $346.74 / $426.58	Professional		$302.00	$346.74	$426.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $120.23	Professional	26	$87.10	$100.00	$120.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $239.88 / $309.03	Professional	TC	$213.80	$239.88	$309.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $91.20 / $151.36	Facility	26	$66.07	$91.20	$151.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $323.59 / $478.63	Professional		$177.83	$323.59	$478.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $95.50 / $147.91	Professional	26	$47.86	$95.50	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $229.09 / $331.13	Professional	TC	$123.03	$229.09	$331.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $93.33	Professional	26	$57.54	$77.62	$93.33
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $229.09	Professional	TC	$154.88	$190.55	$229.09
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $467.74	Professional		$269.15	$338.84	$467.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $100.00 / $138.04	Professional	26	$63.10	$100.00	$138.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $331.13	Professional	TC	$162.18	$245.47	$331.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $309.03 / $309.03 / $309.03	Facility	26	$309.03	$309.03	$309.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $338.84 / $436.52	Professional		$288.40	$338.84	$436.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $100.00 / $125.89	Professional	26	$83.18	$100.00	$125.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $234.42 / $302.00	Professional	TC	$204.17	$234.42	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $446.68	Professional		$173.78	$213.80	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $63.10 / $128.82	Professional	26	$51.29	$63.10	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $147.91 / $316.23	Professional	TC	$120.23	$147.91	$316.23