Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.29 / $119.91 / $729.88	Facility	26	$84.29	$119.91	$729.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $214.77 / $319.41 / $1,031.00	Professional		$214.77	$319.41	$1,031.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.52 / $91.00 / $285.00	Professional	26	$62.52	$91.00	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.07 / $183.73 / $440.26	Professional	TC	$147.07	$183.73	$440.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.27 / $473.34 / $704.77	Professional		$263.27	$473.34	$704.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.70 / $129.44 / $186.23	Professional	26	$77.70	$129.44	$186.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.67 / $347.55 / $518.54	Professional	TC	$192.67	$347.55	$518.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $413.01 / $481.32 / $585.20	Professional		$413.01	$481.32	$585.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $113.89 / $134.77 / $155.52	Professional	26	$113.89	$134.77	$155.52
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $297.33 / $347.92 / $429.68	Professional	TC	$297.33	$347.92	$429.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $338.10 / $394.68 / $669.96	Professional		$338.10	$394.68	$669.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $96.06 / $121.44 / $190.96	Professional	26	$96.06	$121.44	$190.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.96 / $273.24 / $493.34	Professional	TC	$190.96	$273.24	$493.34
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $88.69 / $119.21 / $123.08	Facility	26	$88.69	$119.21	$123.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.93 / $115.21 / $131.84	Professional	26	$83.93	$115.21	$131.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $199.28 / $281.24 / $344.88	Professional	TC	$199.28	$281.24	$344.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $376.36 / $486.97 / $642.54	Professional		$376.36	$486.97	$642.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.99 / $133.22 / $174.78	Professional	26	$81.99	$133.22	$174.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $211.96 / $351.06 / $471.19	Professional	TC	$211.96	$351.06	$471.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,640.24 / $1,640.24 / $1,640.24	Facility	26	$1,640.24	$1,640.24	$1,640.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $416.82 / $513.57 / $631.02	Professional		$416.82	$513.57	$631.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $113.85 / $140.49 / $170.55	Professional	26	$113.85	$140.49	$170.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $302.97 / $373.08 / $460.21	Professional	TC	$302.97	$373.08	$460.21
United Facility/Professional Professional Modifier Low / Median / High Price $256.62 / $460.60 / $680.11	Professional		$256.62	$460.60	$680.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.78 / $126.70 / $191.51	Professional	26	$68.78	$126.70	$191.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.58 / $333.90 / $509.61	Professional	TC	$193.58	$333.90	$509.61