Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $159.65 / $230.42 / $519.95	Facility	26	$159.65	$230.42	$519.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.74 / $449.47 / $872.84	Professional		$293.74	$449.47	$872.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $124.24 / $255.26	Professional	26	$89.57	$124.24	$255.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.15 / $251.86 / $609.12	Professional	TC	$204.15	$251.86	$609.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $482.66 / $755.12 / $969.55	Professional		$482.66	$755.12	$969.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $146.10 / $218.37 / $280.58	Professional	26	$146.10	$218.37	$280.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $336.56 / $527.29 / $694.82	Professional	TC	$336.56	$527.29	$694.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $703.41 / $822.30 / $952.78	Professional		$703.41	$822.30	$952.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $199.32 / $238.94 / $269.99	Professional	26	$199.32	$238.94	$269.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $504.08 / $581.54 / $682.79	Professional	TC	$504.08	$581.54	$682.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $532.55 / $608.40 / $1,051.17	Professional		$532.55	$608.40	$1,051.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.45 / $235.63 / $328.89	Professional	26	$165.45	$235.63	$328.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $394.42 / $561.74 / $784.05	Professional	TC	$394.42	$561.74	$784.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.57 / $191.62 / $204.35	Facility	26	$138.57	$191.62	$204.35
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $323.43 / $347.03 / $347.03	Professional		$323.43	$347.03	$347.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.61 / $167.75 / $204.35	Professional	26	$122.61	$167.75	$204.35
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $292.66 / $406.39 / $487.05	Professional	TC	$292.66	$406.39	$487.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $534.54 / $797.21 / $1,013.65	Professional		$534.54	$797.21	$1,013.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $135.90 / $215.75 / $280.58	Professional	26	$135.90	$215.75	$280.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $324.80 / $504.41 / $694.82	Professional	TC	$324.80	$504.41	$694.82
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,406.69 / $2,406.69 / $2,406.69	Facility	26	$2,406.69	$2,406.69	$2,406.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $618.85 / $811.44 / $979.72	Professional		$618.85	$811.44	$979.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $181.94 / $236.83 / $288.04	Professional	26	$181.94	$236.83	$288.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $436.91 / $574.61 / $691.68	Professional	TC	$436.91	$574.61	$691.68
United Facility/Professional Professional Modifier Low / Median / High Price $406.95 / $434.88 / $1,100.06	Professional		$406.95	$434.88	$1,100.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.01 / $137.82 / $323.43	Professional	26	$128.01	$137.82	$323.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.94 / $296.38 / $810.28	Professional	TC	$278.94	$296.38	$810.28