Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.10 / $85.17 / $191.12	Facility	26	$59.10	$85.17	$191.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.23 / $280.99 / $1,006.00	Professional		$171.23	$280.99	$1,006.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.51 / $57.37 / $167.00	Professional	26	$31.51	$57.37	$167.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $153.44 / $266.55 / $786.00	Professional	TC	$153.44	$266.55	$786.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $417.59 / $561.29 / $775.65	Professional		$417.59	$561.29	$775.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.75 / $79.54 / $101.09	Professional	26	$52.75	$79.54	$101.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $364.84 / $490.40 / $674.56	Professional	TC	$364.84	$490.40	$674.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $544.62 / $633.00 / $737.70	Professional		$544.62	$633.00	$737.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.61 / $87.05 / $98.35	Professional	26	$72.61	$87.05	$98.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $472.04 / $544.50 / $639.38	Professional	TC	$472.04	$544.50	$639.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $271.32 / $439.60 / $820.41	Professional		$271.32	$439.60	$820.41
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.31 / $75.72 / $119.88	Professional	26	$60.31	$75.72	$119.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $265.32 / $470.61 / $733.11	Professional	TC	$265.32	$470.61	$733.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $49.98 / $69.01 / $75.04	Facility	26	$49.98	$69.01	$75.04
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $86.08 / $86.08 / $86.08	Professional		$86.08	$86.08	$86.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.62 / $60.77 / $76.65	Professional	26	$44.62	$60.77	$76.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $258.20 / $374.49 / $472.99	Professional	TC	$258.20	$374.49	$472.99
Providence Facility/Professional Professional Modifier Low / Median / High Price $360.59 / $597.91 / $783.76	Professional		$360.59	$597.91	$783.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.28 / $72.29 / $100.45	Professional	26	$50.28	$72.29	$100.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $310.31 / $475.62 / $655.47	Professional	TC	$310.31	$475.62	$655.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $422.45 / $422.45 / $422.45	Facility	26	$422.45	$422.45	$422.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $485.12 / $637.94 / $764.63	Professional		$485.12	$637.94	$764.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.54 / $86.97 / $107.07	Professional	26	$67.54	$86.97	$107.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $419.69 / $549.85 / $657.57	Professional	TC	$419.69	$549.85	$657.57
United Facility/Professional Professional Modifier Low / Median / High Price $339.43 / $366.58 / $858.57	Professional		$339.43	$366.58	$858.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.74 / $60.80 / $125.03	Professional	26	$44.74	$60.80	$125.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.07 / $305.85 / $738.35	Professional	TC	$198.07	$305.85	$738.35