Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.20 / $111.71 / $247.90	Facility	26	$84.20	$111.71	$247.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.82 / $347.11 / $828.60	Professional		$293.82	$347.11	$828.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $68.45 / $264.00	Professional	26	$43.47	$68.45	$264.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $250.34 / $299.43 / $702.68	Professional	TC	$250.34	$299.43	$702.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $544.65 / $737.50 / $959.65	Professional		$544.65	$737.50	$959.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.30 / $111.77 / $144.56	Professional	26	$81.30	$111.77	$144.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $462.11 / $625.73 / $815.26	Professional	TC	$462.11	$625.73	$815.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $312.99 / $698.73 / $746.61	Professional		$312.99	$698.73	$746.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $48.80 / $112.53 / $116.41	Professional	26	$48.80	$112.53	$116.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $264.20 / $584.20 / $630.23	Professional	TC	$264.20	$584.20	$630.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $474.47 / $539.84 / $943.20	Professional		$474.47	$539.84	$943.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.45 / $111.74 / $155.96	Professional	26	$78.45	$111.74	$155.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $396.02 / $564.02 / $787.23	Professional	TC	$396.02	$564.02	$787.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $73.16 / $97.20 / $101.17	Facility	26	$73.16	$97.20	$101.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $59.90 / $87.91 / $104.19	Professional	26	$59.90	$87.91	$104.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $324.82 / $471.96 / $598.20	Professional	TC	$324.82	$471.96	$598.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $497.42 / $740.80 / $861.70	Professional		$497.42	$740.80	$861.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.38 / $101.79 / $144.56	Professional	26	$79.38	$101.79	$144.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $457.03 / $585.99 / $815.26	Professional	TC	$457.03	$585.99	$815.26
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,526.97 / $1,526.97 / $1,526.97	Facility	26	$1,526.97	$1,526.97	$1,526.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $583.38 / $746.66 / $877.39	Professional		$583.38	$746.66	$877.39
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $92.61 / $117.81 / $139.28	Professional	26	$92.61	$117.81	$139.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $490.77 / $626.04 / $738.10	Professional	TC	$490.77	$626.04	$738.10
United Facility/Professional Professional Modifier Low / Median / High Price $292.64 / $359.96 / $985.18	Professional		$292.64	$359.96	$985.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.72 / $156.38	Professional	26	$45.71	$58.72	$156.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $246.94 / $303.91 / $828.80	Professional	TC	$246.94	$303.91	$828.80