Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.67 / $77.91 / $173.50	Facility	26	$58.67	$77.91	$173.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.52 / $340.39 / $812.96	Professional		$300.52	$340.39	$812.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $47.70 / $168.07	Professional	26	$30.39	$47.70	$168.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.12 / $312.10 / $728.94	Professional	TC	$270.12	$312.10	$728.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $534.54 / $723.80 / $949.51	Professional		$534.54	$723.80	$949.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.39 / $77.94 / $101.29	Professional	26	$56.39	$77.94	$101.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $477.43 / $645.86 / $849.35	Professional	TC	$477.43	$645.86	$849.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $307.17 / $684.54 / $732.73	Professional		$307.17	$684.54	$732.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $78.54 / $81.25	Professional	26	$34.06	$78.54	$81.25
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $273.11 / $603.91 / $651.48	Professional	TC	$273.11	$603.91	$651.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $482.50 / $533.12 / $923.02	Professional		$482.50	$533.12	$923.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $78.30 / $109.29	Professional	26	$54.98	$78.30	$109.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $409.37 / $583.04 / $817.35	Professional	TC	$409.37	$583.04	$817.35
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.39 / $67.81 / $69.68	Facility	26	$50.39	$67.81	$69.68
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 $41.81 / $60.11 / $72.09	Professional	26	$41.81	$60.11	$72.09
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.80 / $491.53 / $613.50	Professional	TC	$346.80	$491.53	$613.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $491.23 / $724.80 / $856.46	Professional		$491.23	$724.80	$856.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.07 / $70.61 / $101.29	Professional	26	$55.07	$70.61	$101.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $476.97 / $612.15 / $849.35	Professional	TC	$476.97	$612.15	$849.35
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 $571.41 / $730.25 / $859.38	Professional		$571.41	$730.25	$859.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $64.89 / $81.68 / $97.59	Professional	26	$64.89	$81.68	$97.59
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $506.52 / $645.73 / $761.79	Professional	TC	$506.52	$645.73	$761.79
United Facility/Professional Professional Modifier Low / Median / High Price $287.74 / $336.52 / $964.97	Professional		$287.74	$336.52	$964.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.59 / $39.13 / $109.57	Professional	26	$31.59	$39.13	$109.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.14 / $299.52 / $855.40	Professional	TC	$256.14	$299.52	$855.40