Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.86 / $185.98 / $205.22	Facility	26	$117.86	$185.98	$205.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $306.00 / $421.10 / $1,411.00	Professional		$306.00	$421.10	$1,411.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.09 / $110.12 / $263.57	Professional	26	$84.09	$110.12	$263.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $221.90 / $310.98 / $713.29	Professional	TC	$221.90	$310.98	$713.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $393.24 / $697.45 / $886.02	Professional		$393.24	$697.45	$886.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.72 / $189.64 / $273.02	Professional	26	$123.72	$189.64	$273.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $269.52 / $502.91 / $642.15	Professional	TC	$269.52	$502.91	$642.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $456.51 / $650.25 / $751.49	Professional		$456.51	$650.25	$751.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $133.87 / $189.25 / $213.08	Professional	26	$133.87	$189.25	$213.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $327.07 / $458.53 / $538.41	Professional	TC	$327.07	$458.53	$538.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $403.68 / $511.98 / $882.71	Professional		$403.68	$511.98	$882.71
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $133.44 / $172.17 / $265.25	Professional	26	$133.44	$172.17	$265.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $310.63 / $446.16 / $617.49	Professional	TC	$310.63	$446.16	$617.49
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $119.19 / $162.81 / $166.16	Facility	26	$119.19	$162.81	$166.16
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $160.93 / $160.93 / $527.90	Professional		$160.93	$160.93	$527.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $98.40 / $148.34 / $182.04	Professional	26	$98.40	$148.34	$182.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $218.74 / $321.92 / $437.10	Professional	TC	$218.74	$321.92	$437.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $491.04 / $716.30 / $886.02	Professional		$491.04	$716.30	$886.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $129.69 / $189.64 / $243.88	Professional	26	$129.69	$189.64	$243.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $282.54 / $502.91 / $642.15	Professional	TC	$282.54	$502.91	$642.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,906.19 / $1,906.19 / $1,906.19	Facility	26	$1,906.19	$1,906.19	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $555.99 / $739.27 / $945.15	Professional		$555.99	$739.27	$945.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.13 / $203.48 / $260.14	Professional	26	$153.13	$203.48	$260.14
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $402.85 / $535.79 / $685.00	Professional	TC	$402.85	$535.79	$685.00
United Facility/Professional Professional Modifier Low / Median / High Price $432.00 / $671.57 / $961.76	Professional		$432.00	$671.57	$961.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.79 / $183.37 / $264.91	Professional	26	$128.79	$183.37	$264.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $313.11 / $388.60 / $690.37	Professional	TC	$313.11	$388.60	$690.37