Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.49 / $56.92 / $114.79	Facility	26	$39.49	$56.92	$114.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $211.65 / $339.20 / $1,127.82	Professional		$211.65	$339.20	$1,127.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.60 / $32.11 / $58.96	Professional	26	$20.60	$32.11	$58.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.47 / $240.72 / $595.33	Professional	TC	$135.47	$240.72	$595.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $392.63 / $531.65 / $678.97	Professional		$392.63	$531.65	$678.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.90 / $52.43 / $67.33	Professional	26	$37.90	$52.43	$67.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $353.90 / $479.21 / $611.41	Professional	TC	$353.90	$479.21	$611.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $226.44 / $504.44 / $540.15	Professional		$226.44	$504.44	$540.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.89 / $52.78 / $54.60	Professional	26	$22.89	$52.78	$54.60
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $203.54 / $450.10 / $485.53	Professional	TC	$203.54	$450.10	$485.53
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $342.11 / $384.16 / $677.50	Professional		$342.11	$384.16	$677.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.83 / $52.45 / $73.20	Professional	26	$36.83	$52.45	$73.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $305.27 / $434.80 / $606.92	Professional	TC	$305.27	$434.80	$606.92
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $45.50 / $47.57	Facility	26	$34.29	$45.50	$47.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $41.61 / $52.50	Professional	26	$28.14	$41.61	$52.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $243.61 / $365.28 / $468.10	Professional	TC	$243.61	$365.28	$468.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $358.62 / $531.65 / $627.00	Professional		$358.62	$531.65	$627.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.02 / $47.46 / $67.33	Professional	26	$37.02	$47.46	$67.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $351.32 / $450.45 / $611.41	Professional	TC	$351.32	$450.45	$611.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,177.68 / $1,177.68 / $1,177.68	Facility	26	$1,177.68	$1,177.68	$1,177.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $419.58 / $535.79 / $631.04	Professional		$419.58	$535.79	$631.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $54.98 / $65.38	Professional	26	$42.70	$54.98	$65.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $376.11 / $479.99 / $565.66	Professional	TC	$376.11	$479.99	$565.66
United Facility/Professional Professional Modifier Low / Median / High Price $210.43 / $351.29 / $709.03	Professional		$210.43	$351.29	$709.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.07 / $33.60 / $73.40	Professional	26	$21.07	$33.60	$73.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $189.26 / $225.30 / $635.16	Professional	TC	$189.26	$225.30	$635.16