Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.72 / $107.09 / $237.70	Facility	26	$80.72	$107.09	$237.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $219.23 / $322.95 / $1,356.12	Professional		$219.23	$322.95	$1,356.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $65.63 / $241.00	Professional	26	$43.47	$65.63	$241.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.34 / $274.68 / $744.80	Professional	TC	$187.34	$274.68	$744.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $568.61 / $769.95 / $994.21	Professional		$568.61	$769.95	$994.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.04 / $107.18 / $137.41	Professional	26	$77.04	$107.18	$137.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $489.46 / $662.76 / $857.37	Professional	TC	$489.46	$662.76	$857.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $327.63 / $731.09 / $781.54	Professional		$327.63	$731.09	$781.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $46.80 / $107.92 / $111.64	Professional	26	$46.80	$107.92	$111.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $280.83 / $621.00 / $669.90	Professional	TC	$280.83	$621.00	$669.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $496.35 / $554.96 / $982.61	Professional		$496.35	$554.96	$982.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.26 / $95.14 / $149.60	Professional	26	$75.26	$95.14	$149.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $421.10 / $599.74 / $837.09	Professional	TC	$421.10	$599.74	$837.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $69.28 / $93.18 / $95.81	Facility	26	$69.28	$93.18	$95.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $273.14 / $273.14 / $273.14	Professional		$273.14	$273.14	$273.14
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.08 / $87.87 / $105.31	Professional	26	$57.08	$87.87	$105.31
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $366.62 / $505.00 / $643.05	Professional	TC	$366.62	$505.00	$643.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $486.25 / $758.88 / $893.34	Professional		$486.25	$758.88	$893.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.23 / $96.46 / $137.41	Professional	26	$75.23	$96.46	$137.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $480.74 / $616.39 / $857.37	Professional	TC	$480.74	$616.39	$857.37
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 $608.58 / $779.48 / $915.29	Professional		$608.58	$779.48	$915.29
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $86.62 / $111.53 / $133.60	Professional	26	$86.62	$111.53	$133.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $519.75 / $663.78 / $781.69	Professional	TC	$519.75	$663.78	$781.69
United Facility/Professional Professional Modifier Low / Median / High Price $304.00 / $308.70 / $1,027.73	Professional		$304.00	$308.70	$1,027.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.67 / $56.33 / $147.81	Professional	26	$43.67	$56.33	$147.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $260.13 / $323.14 / $877.72	Professional	TC	$260.13	$323.14	$877.72