Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.55 / $66.55 / $104.37	Facility	26	$66.55	$66.55	$104.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.09 / $160.30 / $285.64	Professional		$112.09	$160.30	$285.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.56 / $52.47 / $120.06	Professional	26	$32.56	$52.47	$120.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.47 / $100.14 / $218.29	Professional	TC	$64.47	$100.14	$218.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.63 / $232.77 / $443.78	Professional		$130.63	$232.77	$443.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $81.92 / $119.95	Professional	26	$48.86	$81.92	$119.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $137.33 / $335.17	Professional	TC	$67.61	$137.33	$335.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $312.07 / $370.93 / $430.85	Professional		$312.07	$370.93	$430.85
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.04 / $96.76 / $109.77	Professional	26	$81.04	$96.76	$109.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.01 / $273.44 / $321.08	Professional	TC	$229.01	$273.44	$321.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $180.01 / $267.19 / $415.80	Professional		$180.01	$267.19	$415.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $81.67 / $126.06	Professional	26	$66.70	$81.67	$126.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $143.63 / $205.18 / $323.25	Professional	TC	$143.63	$205.18	$323.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $65.17 / $82.41 / $83.08	Facility	26	$65.17	$82.41	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $70.05 / $91.13	Professional	26	$54.27	$70.05	$91.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $58.90 / $94.31 / $164.58	Professional	TC	$58.90	$94.31	$164.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $184.59 / $265.68 / $407.86	Professional		$184.59	$265.68	$407.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.27 / $85.26 / $121.21	Professional	26	$55.27	$85.26	$121.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $151.06 / $335.17	Professional	TC	$67.61	$151.06	$335.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $203.13 / $272.60 / $400.07	Professional		$203.13	$272.60	$400.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.66 / $88.11 / $117.00	Professional	26	$74.66	$88.11	$117.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $114.19 / $189.95 / $298.20	Professional	TC	$114.19	$189.95	$298.20
United Facility/Professional Professional Modifier Low / Median / High Price $105.74 / $204.55 / $436.56	Professional		$105.74	$204.55	$436.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.03 / $79.31 / $124.93	Professional	26	$44.03	$79.31	$124.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $117.98 / $295.26	Professional	TC	$61.71	$117.98	$295.26