Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $238.12 / $345.90 / $772.10	Facility	26	$238.12	$345.90	$772.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $255.18 / $299.02 / $768.41	Professional		$255.18	$299.02	$768.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $193.60 / $518.04	Professional	26	$131.81	$193.60	$518.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.37 / $152.13 / $376.22	Professional	TC	$123.37	$152.13	$376.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $428.63 / $633.80 / $807.72	Professional		$428.63	$633.80	$807.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $217.10 / $324.76 / $417.98	Professional	26	$217.10	$324.76	$417.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $211.53 / $307.56 / $390.32	Professional	TC	$211.53	$307.56	$390.32
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $578.51 / $682.23 / $783.60	Professional		$578.51	$682.23	$783.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $296.42 / $355.65 / $401.51	Professional	26	$296.42	$355.65	$401.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $282.08 / $325.48 / $382.09	Professional	TC	$282.08	$325.48	$382.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $460.32 / $640.73 / $929.42	Professional		$460.32	$640.73	$929.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $246.58 / $351.18 / $490.16	Professional	26	$246.58	$351.18	$490.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.95 / $314.69 / $439.22	Professional	TC	$220.95	$314.69	$439.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $206.40 / $285.42 / $303.51	Facility	26	$206.40	$285.42	$303.51
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $209.19 / $209.19 / $209.19	Professional		$209.19	$209.19	$209.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $199.32 / $249.15 / $317.37	Professional	26	$199.32	$249.15	$317.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $184.79 / $232.58 / $289.58	Professional	TC	$184.79	$232.58	$289.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $470.23 / $649.38 / $836.14	Professional		$470.23	$649.38	$836.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $201.13 / $318.70 / $417.98	Professional	26	$201.13	$318.70	$417.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $175.76 / $284.63 / $390.32	Professional	TC	$175.76	$284.63	$390.32
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,088.88 / $1,088.88 / $1,088.88	Facility	26	$1,088.88	$1,088.88	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $511.12 / $668.86 / $809.17	Professional		$511.12	$668.86	$809.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $271.12 / $351.75 / $429.22	Professional	26	$271.12	$351.75	$429.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $240.64 / $317.33 / $379.95	Professional	TC	$240.64	$317.33	$379.95
United Facility/Professional Professional Modifier Low / Median / High Price $357.99 / $370.60 / $908.58	Professional		$357.99	$370.60	$908.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $189.10 / $203.59 / $469.31	Professional	26	$189.10	$203.59	$469.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $168.89 / $218.18 / $443.71	Professional	TC	$168.89	$218.18	$443.71