Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.94 / $90.19 / $198.99	Facility	26	$67.94	$90.19	$198.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.62 / $305.83 / $1,433.00	Professional		$229.62	$305.83	$1,433.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.75 / $60.68 / $185.10	Professional	26	$36.75	$60.68	$185.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.87 / $236.59 / $709.49	Professional	TC	$192.87	$236.59	$709.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $487.56 / $657.21 / $778.30	Professional		$487.56	$657.21	$778.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.56 / $90.24 / $115.71	Professional	26	$65.56	$90.24	$115.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $423.54 / $566.96 / $660.28	Professional	TC	$423.54	$566.96	$660.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $278.99 / $622.55 / $665.51	Professional		$278.99	$622.55	$665.51
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.42 / $90.90 / $94.03	Professional	26	$39.42	$90.90	$94.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $239.58 / $529.76 / $571.50	Professional	TC	$239.58	$529.76	$571.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $372.50 / $482.72 / $840.27	Professional		$372.50	$482.72	$840.27
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.51 / $80.40 / $126.25	Professional	26	$63.51	$80.40	$126.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $345.84 / $401.33 / $714.02	Professional	TC	$345.84	$401.33	$714.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.14 / $78.50 / $81.06	Facility	26	$58.14	$78.50	$81.06
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.64 / $72.50 / $88.80	Professional	26	$48.64	$72.50	$88.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $260.86 / $360.18 / $496.47	Professional	TC	$260.86	$360.18	$496.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $396.90 / $637.88 / $765.59	Professional		$396.90	$637.88	$765.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.02 / $82.09 / $115.71	Professional	26	$64.02	$82.09	$115.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $418.71 / $543.04 / $660.28	Professional	TC	$418.71	$543.04	$660.28
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 $466.79 / $662.96 / $781.69	Professional		$466.79	$662.96	$781.69
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.59 / $94.25 / $112.75	Professional	26	$72.59	$94.25	$112.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $393.60 / $566.15 / $668.94	Professional	TC	$393.60	$566.15	$668.94
United Facility/Professional Professional Modifier Low / Median / High Price $223.27 / $269.31 / $877.72	Professional		$223.27	$269.31	$877.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.65 / $37.11 / $126.62	Professional	26	$36.65	$37.11	$126.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.62 / $227.31 / $758.77	Professional	TC	$186.62	$227.31	$758.77