Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.10 / $97.10 / $106.51	Facility	26	$97.10	$97.10	$106.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.46 / $168.49 / $368.93	Professional		$144.46	$168.49	$368.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.89 / $53.04 / $114.87	Professional	26	$44.89	$53.04	$114.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.57 / $117.26 / $259.64	Professional	TC	$99.57	$117.26	$259.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $180.65 / $296.41 / $423.78	Professional		$180.65	$296.41	$423.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.93 / $91.26 / $131.69	Professional	26	$55.93	$91.26	$131.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.62 / $206.98 / $283.97	Professional	TC	$121.62	$206.98	$283.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $259.27 / $302.17 / $366.46	Professional		$259.27	$302.17	$366.46
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $80.98 / $95.80 / $110.57	Professional	26	$80.98	$95.80	$110.57
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.08 / $207.20 / $255.89	Professional	TC	$177.08	$207.20	$255.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $194.58 / $243.66 / $415.80	Professional		$194.58	$243.66	$415.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.31 / $88.17 / $135.79	Professional	26	$68.31	$88.17	$135.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.84 / $195.76 / $293.89	Professional	TC	$147.84	$195.76	$293.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $62.72 / $84.73 / $88.40	Facility	26	$62.72	$84.73	$88.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $78.39 / $93.44	Professional	26	$54.27	$78.39	$93.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $108.98 / $151.62 / $208.19	Professional	TC	$108.98	$151.62	$208.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $231.21 / $302.45 / $394.25	Professional		$231.21	$302.45	$394.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.44 / $94.95 / $123.73	Professional	26	$58.44	$94.95	$123.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $127.89 / $206.98 / $276.47	Professional	TC	$127.89	$206.98	$276.47
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 $240.50 / $319.22 / $387.53	Professional		$240.50	$319.22	$387.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $80.95 / $99.12 / $121.81	Professional	26	$80.95	$99.12	$121.81
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $157.30 / $220.10 / $266.25	Professional	TC	$157.30	$220.10	$266.25
United Facility/Professional Professional Modifier Low / Median / High Price $155.61 / $271.32 / $413.28	Professional		$155.61	$271.32	$413.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.21 / $89.59 / $132.57	Professional	26	$53.21	$89.59	$132.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.65 / $178.87 / $280.13	Professional	TC	$106.65	$178.87	$280.13