Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.05 / $240.18 / $541.67	Facility	26	$167.05	$240.18	$541.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.26 / $209.41 / $744.49	Professional		$170.26	$209.41	$744.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.92 / $135.82 / $422.36	Professional	26	$90.92	$135.82	$422.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.45 / $99.02 / $149.44	Professional	TC	$34.45	$99.02	$149.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.37 / $314.44 / $447.33	Professional		$208.37	$314.44	$447.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $154.85 / $227.34 / $294.07	Professional	26	$154.85	$227.34	$294.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.10 / $71.94 / $145.33	Professional	TC	$50.10	$71.94	$145.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $286.99 / $340.96 / $388.74	Professional		$286.99	$340.96	$388.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $207.51 / $248.84 / $281.07	Professional	26	$207.51	$248.84	$281.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.51 / $91.73 / $107.69	Professional	TC	$79.51	$91.73	$107.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $212.24 / $257.60 / $466.81	Professional		$212.24	$257.60	$466.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $172.39 / $210.00 / $323.27	Professional	26	$172.39	$210.00	$323.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.45 / $88.95 / $441.35	Professional	TC	$62.45	$88.95	$441.35
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $144.87 / $200.33 / $213.06	Facility	26	$144.87	$200.33	$213.06
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $34.54 / $34.54 / $34.54	Professional		$34.54	$34.54	$34.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $136.34 / $182.04 / $231.04	Professional	26	$136.34	$182.04	$231.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $44.72 / $66.75 / $138.57	Professional	TC	$44.72	$66.75	$138.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $235.48 / $319.97 / $413.22	Professional		$235.48	$319.97	$413.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $141.79 / $204.44 / $293.02	Professional	26	$141.79	$204.44	$293.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.51 / $70.06 / $109.58	Professional	TC	$38.51	$70.06	$109.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,760.29 / $1,760.29 / $1,760.29	Facility	26	$1,760.29	$1,760.29	$1,760.29
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $253.64 / $319.47 / $393.21	Professional		$253.64	$319.47	$393.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $190.32 / $246.93 / $301.30	Professional	26	$190.32	$246.93	$301.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $56.55 / $77.53 / $91.91	Professional	TC	$56.55	$77.53	$91.91
United Facility/Professional Professional Modifier Low / Median / High Price $170.98 / $276.67 / $459.19	Professional		$170.98	$276.67	$459.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $134.13 / $146.53 / $329.44	Professional	26	$134.13	$146.53	$329.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.47 / $59.74 / $107.66	Professional	TC	$32.47	$59.74	$107.66