Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.34 / $112.99 / $228.10	Facility	26	$102.34	$112.99	$228.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.94 / $321.77 / $1,312.00	Professional		$144.94	$321.77	$1,312.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.56 / $62.79 / $235.00	Professional	26	$30.56	$62.79	$235.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.39 / $227.42 / $456.53	Professional	TC	$114.39	$227.42	$456.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $373.15 / $505.28 / $654.69	Professional		$373.15	$505.28	$654.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.31 / $102.55 / $131.99	Professional	26	$74.31	$102.55	$131.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $297.42 / $402.73 / $522.69	Professional	TC	$297.42	$402.73	$522.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $216.92 / $485.48 / $517.45	Professional		$216.92	$485.48	$517.45
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.78 / $103.26 / $106.82	Professional	26	$44.78	$103.26	$106.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $172.15 / $380.68 / $410.65	Professional	TC	$172.15	$380.68	$410.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $330.36 / $369.04 / $650.38	Professional		$330.36	$369.04	$650.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.06 / $95.81 / $143.24	Professional	26	$72.06	$95.81	$143.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $258.32 / $367.92 / $513.52	Professional	TC	$258.32	$367.92	$513.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.38 / $89.18 / $92.48	Facility	26	$66.38	$89.18	$92.48
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $245.84 / $270.14 / $274.89	Professional		$245.84	$270.14	$274.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $55.07 / $82.61 / $100.16	Professional	26	$55.07	$82.61	$100.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $213.06 / $312.23 / $393.38	Professional	TC	$213.06	$312.23	$393.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $340.04 / $505.28 / $591.29	Professional		$340.04	$505.28	$591.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.56 / $93.04 / $131.99	Professional	26	$72.56	$93.04	$131.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $293.98 / $376.93 / $522.69	Professional	TC	$293.98	$376.93	$522.69
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 $401.31 / $517.58 / $603.55	Professional		$401.31	$517.58	$603.55
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $82.96 / $107.60 / $127.91	Professional	26	$82.96	$107.60	$127.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $316.26 / $406.97 / $475.65	Professional	TC	$316.26	$406.97	$475.65
United Facility/Professional Professional Modifier Low / Median / High Price $199.70 / $250.50 / $677.70	Professional		$199.70	$250.50	$677.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.54 / $45.51 / $143.63	Professional	26	$41.54	$45.51	$143.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.68 / $198.12 / $531.27	Professional	TC	$157.68	$198.12	$531.27