Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.10 / $131.10 / $194.21	Facility	26	$131.10	$131.10	$194.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.78 / $182.41 / $568.17	Professional		$133.78	$182.41	$568.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.04 / $87.37 / $300.83	Professional	26	$72.04	$87.37	$300.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.21 / $67.67 / $125.50	Professional	TC	$57.21	$67.67	$125.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.73 / $88.73 / $88.73	Facility	26	$88.73	$88.73	$88.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.39 / $287.92 / $395.32	Professional		$181.39	$287.92	$395.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.04 / $163.24 / $222.56	Professional	26	$101.04	$163.24	$222.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.34 / $130.79 / $176.46	Professional	TC	$80.34	$130.79	$176.46
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $237.01 / $309.02 / $354.31	Professional		$237.01	$309.02	$354.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $137.10 / $178.75 / $201.83	Professional	26	$137.10	$178.75	$201.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $99.91 / $129.87 / $152.47	Professional	TC	$99.91	$129.87	$152.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $211.89 / $253.48 / $405.63	Professional		$211.89	$253.48	$405.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.82 / $150.08 / $246.13	Professional	26	$123.82	$150.08	$246.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $88.06 / $106.74 / $175.05	Professional	TC	$88.06	$106.74	$175.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $111.44 / $153.52 / $155.44	Facility	26	$111.44	$153.52	$155.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $92.46 / $130.97 / $162.15	Professional	26	$92.46	$130.97	$162.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $100.89 / $135.10	Professional	TC	$77.59	$100.89	$135.10
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $88.73 / $88.73 / $88.73	Facility	26	$88.73	$88.73	$88.73
Providence Facility/Professional Professional Modifier Low / Median / High Price $184.37 / $294.00 / $383.53	Professional		$184.37	$294.00	$383.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $105.55 / $163.24 / $222.56	Professional	26	$105.55	$163.24	$222.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.90 / $133.33 / $178.75	Professional	TC	$79.90	$133.33	$178.75
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 $215.46 / $275.32 / $378.05	Professional		$215.46	$275.32	$378.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $124.74 / $153.96 / $218.87	Professional	26	$124.74	$153.96	$218.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $90.72 / $123.38 / $159.18	Professional	TC	$90.72	$123.38	$159.18
United Facility/Professional Professional Modifier Low / Median / High Price $203.09 / $276.05 / $420.55	Professional		$203.09	$276.05	$420.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $119.61 / $168.33 / $239.32	Professional	26	$119.61	$168.33	$239.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.16 / $128.51 / $179.07	Professional	TC	$90.16	$128.51	$179.07