Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.02 / $616.24 / $633.55	Facility	26	$112.02	$616.24	$633.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.75 / $254.77 / $994.00	Professional		$204.75	$254.77	$994.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.81 / $89.37 / $330.20	Professional	26	$71.81	$89.37	$330.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.27 / $150.96 / $326.13	Professional	TC	$130.27	$150.96	$326.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.14 / $412.84 / $606.00	Professional		$244.14	$412.84	$606.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.01 / $145.11 / $207.83	Professional	26	$90.01	$145.11	$207.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $152.66 / $269.07 / $398.17	Professional	TC	$152.66	$269.07	$398.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.56 / $408.53 / $493.55	Professional		$350.56	$408.53	$493.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $127.92 / $151.38 / $174.68	Professional	26	$127.92	$151.38	$174.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $220.66 / $258.20 / $318.87	Professional	TC	$220.66	$258.20	$318.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $291.95 / $354.42 / $563.22	Professional		$291.95	$354.42	$563.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.81 / $140.22 / $214.32	Professional	26	$107.81	$140.22	$214.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.14 / $228.92 / $366.05	Professional	TC	$184.14	$228.92	$366.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $97.87 / $133.90 / $138.04	Facility	26	$97.87	$133.90	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.97 / $122.41 / $151.50	Professional	26	$93.97	$122.41	$151.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $166.03 / $230.40 / $320.26	Professional	TC	$166.03	$230.40	$320.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $339.34 / $431.01 / $545.14	Professional		$339.34	$431.01	$545.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $91.96 / $149.41 / $195.17	Professional	26	$91.96	$149.41	$195.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $162.72 / $274.23 / $348.12	Professional	TC	$162.72	$274.23	$348.12
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 $350.78 / $439.40 / $528.47	Professional		$350.78	$439.40	$528.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $127.13 / $157.66 / $190.45	Professional	26	$127.13	$157.66	$190.45
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $223.51 / $278.99 / $338.26	Professional	TC	$223.51	$278.99	$338.26
United Facility/Professional Professional Modifier Low / Median / High Price $209.14 / $401.62 / $583.92	Professional		$209.14	$401.62	$583.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.08 / $141.40 / $208.78	Professional	26	$80.08	$141.40	$208.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.16 / $274.38 / $391.86	Professional	TC	$133.16	$274.38	$391.86