Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.89 / $143.99 / $319.62	Facility	26	$108.89	$143.99	$319.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.22 / $481.38 / $1,957.00	Professional		$216.22	$481.38	$1,957.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $88.53 / $336.00	Professional	26	$42.94	$88.53	$336.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.28 / $392.86 / $690.68	Professional	TC	$173.28	$392.86	$690.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $554.85 / $751.30 / $971.39	Professional		$554.85	$751.30	$971.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.72 / $144.09 / $185.86	Professional	26	$103.72	$144.09	$185.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $448.44 / $607.22 / $787.18	Professional	TC	$448.44	$607.22	$787.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $322.43 / $720.87 / $769.13	Professional		$322.43	$720.87	$769.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $62.88 / $145.00 / $150.00	Professional	26	$62.88	$145.00	$150.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $259.56 / $573.94 / $619.16	Professional	TC	$259.56	$573.94	$619.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $489.95 / $540.09 / $966.54	Professional		$489.95	$540.09	$966.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.86 / $143.66 / $200.51	Professional	26	$100.86	$143.66	$200.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $389.09 / $554.15 / $773.46	Professional	TC	$389.09	$554.15	$773.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $92.54 / $125.23 / $127.97	Facility	26	$92.54	$125.23	$127.97
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $854.96 / $857.90 / $1,612.45	Professional		$854.96	$857.90	$1,612.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $76.40 / $122.24 / $143.25	Professional	26	$76.40	$122.24	$143.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $322.00 / $480.60 / $599.40	Professional	TC	$322.00	$480.60	$599.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $480.12 / $751.14 / $878.74	Professional		$480.12	$751.14	$878.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $101.28 / $129.85 / $185.86	Professional	26	$101.28	$129.85	$185.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $444.35 / $569.73 / $787.18	Professional	TC	$444.35	$569.73	$787.18
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,053.27 / $4,053.27 / $4,053.27	Facility	26	$4,053.27	$4,053.27	$4,053.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $595.35 / $767.34 / $895.39	Professional		$595.35	$767.34	$895.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.12 / $150.01 / $179.08	Professional	26	$117.12	$150.01	$179.08
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $476.28 / $615.38 / $716.31	Professional	TC	$476.28	$615.38	$716.31
United Facility/Professional Professional Modifier Low / Median / High Price $295.41 / $375.08 / $1,005.37	Professional		$295.41	$375.08	$1,005.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.03 / $156.09 / $196.38	Professional	26	$58.03	$156.09	$196.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $237.12 / $427.67 / $804.28	Professional	TC	$237.12	$427.67	$804.28