Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $102.33 / $109.65	Facility	26	$57.54	$102.33	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $281.84	Professional		$114.82	$147.91	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $46.77 / $81.28	Professional	26	$40.74	$46.77	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $95.50 / $154.88	Professional	TC	$72.44	$95.50	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $245.47 / $426.58	Professional		$138.04	$245.47	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $85.11 / $125.89	Professional	26	$48.98	$85.11	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $158.49 / $295.12	Professional	TC	$87.10	$158.49	$295.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $269.15 / $323.59	Professional		$218.78	$269.15	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $112.20	Professional	26	$77.62	$95.50	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $177.83 / $208.93	Professional	TC	$141.25	$177.83	$208.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $245.47 / $398.11	Professional		$151.36	$245.47	$398.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $83.18 / $123.03	Professional	26	$48.98	$83.18	$123.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $151.36 / $204.17	Professional	TC	$89.13	$151.36	$204.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $87.10 / $89.13	Facility	26	$72.44	$87.10	$89.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $97.72	Professional	26	$60.26	$75.86	$97.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $158.49 / $269.15	Professional	TC	$109.65	$158.49	$269.15
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $50.12 / $70.79	Facility	26	$10.72	$50.12	$70.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $257.04 / $380.19	Professional		$181.97	$257.04	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $87.10 / $123.03	Professional	26	$57.54	$87.10	$123.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $162.18 / $295.12	Professional	TC	$104.71	$162.18	$295.12
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $257.04 / $363.08	Professional		$199.53	$257.04	$363.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $87.10 / $117.49	Professional	26	$70.79	$87.10	$117.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $234.42	Professional	TC	$128.82	$169.82	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $257.04 / $389.05	Professional		$138.04	$257.04	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $91.20 / $131.83	Professional	26	$53.70	$91.20	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $162.18 / $263.03	Professional	TC	$83.18	$162.18	$263.03