Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $165.96 / $204.17	Facility	26	$109.65	$165.96	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $323.59 / $1,148.15	Professional		$229.09	$323.59	$1,148.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $416.87	Professional	26	$79.43	$117.49	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $177.83 / $316.23	Professional	TC	$141.25	$177.83	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $457.09 / $660.69	Professional		$295.12	$457.09	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $154.88 / $234.42	Professional	26	$100.00	$154.88	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $295.12 / $436.52	Professional	TC	$177.83	$295.12	$436.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $489.78 / $616.60	Professional		$398.11	$489.78	$616.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $169.82 / $204.17	Professional	26	$131.83	$169.82	$204.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $323.59 / $407.38	Professional	TC	$269.15	$323.59	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $138.04 / $165.96	Facility	26	$109.65	$138.04	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $436.52 / $645.65	Professional		$302.00	$436.52	$645.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $165.96 / $257.04	Professional	26	$93.33	$165.96	$257.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $309.03 / $446.68	Professional	TC	$181.97	$309.03	$446.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $162.18 / $162.18	Facility	26	$131.83	$162.18	$162.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $177.83	Professional	26	$102.33	$138.04	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $269.15 / $363.08	Professional	TC	$208.93	$269.15	$363.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $501.19 / $660.69	Professional		$363.08	$501.19	$660.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $165.96 / $229.09	Professional	26	$114.82	$165.96	$229.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $309.03 / $426.58	Professional	TC	$213.80	$309.03	$426.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Facility	26	$1,621.81	$1,621.81	$1,621.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $501.19 / $645.65	Professional		$416.87	$501.19	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $173.78 / $218.78	Professional	26	$147.91	$173.78	$218.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $323.59 / $416.87	Professional	TC	$269.15	$323.59	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $660.69	Professional		$239.88	$436.52	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $154.88 / $234.42	Professional	26	$87.10	$154.88	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $275.42 / $426.58	Professional	TC	$151.36	$275.42	$426.58