Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.72 / $83.28 / $169.92	Facility	26	$62.72	$83.28	$169.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.87 / $405.35 / $1,427.41	Professional		$251.87	$405.35	$1,427.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.17 / $51.00 / $191.84	Professional	26	$33.17	$51.00	$191.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $268.31 / $711.26	Professional	TC	$218.71	$268.31	$711.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $543.28 / $735.64 / $890.94	Professional		$543.28	$735.64	$890.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.66 / $83.34 / $107.19	Professional	26	$59.66	$83.34	$107.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $481.84 / $652.29 / $783.75	Professional	TC	$481.84	$652.29	$783.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $313.31 / $698.45 / $747.38	Professional		$313.31	$698.45	$747.38
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.40 / $83.96 / $86.85	Professional	26	$36.40	$83.96	$86.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $276.91 / $612.32 / $660.55	Professional	TC	$276.91	$612.32	$660.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $445.23 / $533.12 / $939.46	Professional		$445.23	$533.12	$939.46
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.71 / $72.36 / $116.70	Professional	26	$58.71	$72.36	$116.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $378.18 / $476.37 / $825.44	Professional	TC	$378.18	$476.37	$825.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.78 / $72.48 / $74.80	Facility	26	$53.78	$72.48	$74.80
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 $46.62 / $66.67 / $78.34	Professional	26	$46.62	$66.67	$78.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $327.60 / $436.40 / $584.91	Professional	TC	$327.60	$436.40	$584.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $458.38 / $704.48 / $854.10	Professional		$458.38	$704.48	$854.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.26 / $74.70 / $107.19	Professional	26	$58.26	$74.70	$107.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $481.73 / $617.79 / $783.75	Professional	TC	$481.73	$617.79	$783.75
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 $536.90 / $743.37 / $873.59	Professional		$536.90	$743.37	$873.59
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.70 / $86.39 / $104.23	Professional	26	$67.70	$86.39	$104.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $468.63 / $653.94 / $769.37	Professional	TC	$468.63	$653.94	$769.37
United Facility/Professional Professional Modifier Low / Median / High Price $256.56 / $308.82 / $980.91	Professional		$256.56	$308.82	$980.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $35.49 / $113.97	Professional	26	$33.75	$35.49	$113.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $222.35 / $266.31 / $863.87	Professional	TC	$222.35	$266.31	$863.87