Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $346.74 / $398.11	Facility	26	$251.19	$346.74	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $309.03 / $741.31	Professional		$257.04	$309.03	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $204.17 / $562.34	Professional	26	$131.83	$204.17	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $154.88 / $316.23	Professional	TC	$123.03	$154.88	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $630.96 / $851.14	Professional		$407.38	$630.96	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $323.59 / $446.68	Professional	26	$213.80	$323.59	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $309.03 / $398.11	Professional	TC	$194.98	$309.03	$398.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $676.08 / $794.33	Professional		$309.03	$676.08	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $346.74 / $407.38	Professional	26	$158.49	$346.74	$407.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $323.59 / $389.05	Professional	TC	$154.88	$323.59	$389.05
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $346.74 / $346.74	Facility	26	$239.88	$346.74	$346.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $588.84 / $933.25	Professional		$323.59	$588.84	$933.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $346.74 / $489.78	Professional	26	$162.18	$346.74	$489.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $302.00 / $436.52	Professional	TC	$151.36	$302.00	$436.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $295.12 / $302.00	Facility	26	$245.47	$295.12	$302.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $234.42 / $309.03	Professional	26	$177.83	$234.42	$309.03
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $223.87 / $288.40	Professional	TC	$158.49	$223.87	$288.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $616.60 / $831.76	Professional		$446.68	$616.60	$831.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $316.23 / $446.68	Professional	26	$213.80	$316.23	$446.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $295.12 / $398.11	Professional	TC	$199.53	$295.12	$398.11
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility	26	$1,096.48	$1,096.48	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $588.84 / $758.58	Professional		$512.86	$588.84	$758.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $316.23 / $407.38	Professional	26	$269.15	$316.23	$407.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $275.42 / $354.81	Professional	TC	$239.88	$275.42	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $371.54 / $831.76	Professional		$354.81	$371.54	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $194.98 / $436.52	Professional	26	$190.55	$194.98	$436.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $177.83 / $389.05	Professional	TC	$165.96	$177.83	$389.05