Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $100.00 / $109.65	Facility	26	$57.54	$100.00	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $165.96 / $338.84	Professional		$120.23	$165.96	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $52.48 / $190.55	Professional	26	$39.81	$52.48	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $208.93	Professional	TC	$77.62	$112.20	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $398.11	Professional		$169.82	$263.03	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $125.89	Professional	26	$52.48	$81.28	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $275.42	Professional	TC	$114.82	$181.97	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $288.40 / $363.08	Professional		$234.42	$288.40	$363.08
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $91.20 / $107.15	Professional	26	$70.79	$91.20	$107.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $204.17 / $257.04	Professional	TC	$165.96	$204.17	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $257.04 / $363.08	Professional		$194.98	$257.04	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $125.89	Professional	26	$64.57	$89.13	$125.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $194.98 / $275.42	Professional	TC	$128.82	$194.98	$275.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $85.11 / $89.13	Facility	26	$69.18	$85.11	$89.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $91.20	Professional	26	$53.70	$75.86	$91.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $144.54 / $194.98	Professional	TC	$109.65	$144.54	$194.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $281.84 / $380.19	Professional		$213.80	$281.84	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $89.13 / $117.49	Professional	26	$60.26	$89.13	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $186.21 / $269.15	Professional	TC	$128.82	$186.21	$269.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Facility	26	$1,621.81	$1,621.81	$1,621.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $295.12 / $371.54	Professional		$239.88	$295.12	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $91.20 / $117.49	Professional	26	$79.43	$91.20	$117.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $199.53 / $257.04	Professional	TC	$158.49	$199.53	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $251.19 / $380.19	Professional		$144.54	$251.19	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $81.28 / $123.03	Professional	26	$45.71	$81.28	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $173.78 / $257.04	Professional	TC	$97.72	$173.78	$257.04