Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $114.82 / $125.89	Facility	26	$79.43	$114.82	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $338.84 / $707.95	Professional		$275.42	$338.84	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $58.88 / $158.49	Professional	26	$43.65	$58.88	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $288.40 / $588.84	Professional	TC	$239.88	$288.40	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $776.25 / $1,071.52	Professional		$512.86	$776.25	$1,071.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $151.36	Professional	26	$79.43	$117.49	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $660.69 / $912.01	Professional	TC	$436.52	$660.69	$912.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $630.96 / $741.31	Professional		$316.23	$630.96	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $104.71 / $117.49	Professional	26	$50.12	$104.71	$117.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $524.81 / $630.96	Professional	TC	$269.15	$524.81	$630.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $114.82 / $125.89	Facility	26	$85.11	$114.82	$125.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $676.08 / $954.99	Professional		$338.84	$676.08	$954.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $112.20 / $154.88	Professional	26	$48.98	$112.20	$154.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $575.44 / $794.33	Professional	TC	$275.42	$575.44	$794.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $97.72 / $102.33	Facility	26	$81.28	$97.72	$102.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $426.58 / $426.58	Professional		$354.81	$426.58	$426.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $87.10 / $114.82	Professional	26	$60.26	$87.10	$114.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $467.74 / $660.69	Professional	TC	$331.13	$467.74	$660.69
Providence Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $707.95 / $891.25	Professional		$467.74	$707.95	$891.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $102.33 / $141.25	Professional	26	$70.79	$102.33	$141.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $562.34 / $741.31	Professional	TC	$389.05	$562.34	$741.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility	26	$1,513.56	$1,513.56	$1,513.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $707.95 / $776.25	Professional		$588.84	$707.95	$776.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $104.71 / $125.89	Professional	26	$93.33	$104.71	$125.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $602.56 / $660.69	Professional	TC	$489.78	$602.56	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $331.13 / $977.24	Professional		$295.12	$331.13	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $52.48 / $151.36	Professional	26	$45.71	$52.48	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $275.42 / $831.76	Professional	TC	$245.47	$275.42	$831.76