Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.44 / $141.08 / $277.99	Facility	26	$120.44	$141.08	$277.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.42 / $354.02 / $971.13	Professional		$223.42	$354.02	$971.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $53.78 / $225.12	Professional	26	$37.36	$53.78	$225.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.06 / $336.10 / $1,379.23	Professional	TC	$186.06	$336.10	$1,379.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $574.59 / $778.04 / $1,013.96	Professional		$574.59	$778.04	$1,013.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.59 / $125.74 / $160.90	Professional	26	$90.59	$125.74	$160.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $485.15 / $652.29 / $853.34	Professional	TC	$485.15	$652.29	$853.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.39 / $740.12 / $790.50	Professional		$331.39	$740.12	$790.50
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.70 / $126.14 / $130.47	Professional	26	$54.70	$126.14	$130.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $276.68 / $611.79 / $660.00	Professional	TC	$276.68	$611.79	$660.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $502.76 / $566.72 / $994.67	Professional		$502.76	$566.72	$994.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.06 / $125.42 / $175.05	Professional	26	$88.06	$125.42	$175.05
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $414.69 / $590.63 / $825.48	Professional	TC	$414.69	$590.63	$825.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $80.91 / $108.98 / $111.89	Facility	26	$80.91	$108.98	$111.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $245.84 / $245.84 / $245.84	Professional		$245.84	$245.84	$245.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $100.20 / $131.93	Professional	26	$66.73	$100.20	$131.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $334.06 / $497.17 / $659.09	Professional	TC	$334.06	$497.17	$659.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $529.92 / $780.52 / $928.11	Professional		$529.92	$780.52	$928.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.46 / $113.42 / $160.90	Professional	26	$88.46	$113.42	$160.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $481.73 / $622.04 / $853.34	Professional	TC	$481.73	$622.04	$853.34
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 $616.14 / $788.50 / $926.66	Professional		$616.14	$788.50	$926.66
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.26 / $131.16 / $157.29	Professional	26	$101.26	$131.16	$157.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $511.56 / $653.12 / $769.37	Professional	TC	$511.56	$653.12	$769.37
United Facility/Professional Professional Modifier Low / Median / High Price $310.45 / $375.01 / $1,040.50	Professional		$310.45	$375.01	$1,040.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.93 / $62.45 / $176.60	Professional	26	$50.93	$62.45	$176.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $259.52 / $312.56 / $866.31	Professional	TC	$259.52	$312.56	$866.31