Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.78 / $161.31 / $184.06	Facility	26	$108.78	$161.31	$184.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $240.93 / $302.23 / $1,117.00	Professional		$240.93	$302.23	$1,117.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.26 / $108.78 / $378.00	Professional	26	$87.26	$108.78	$378.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.16 / $180.53 / $378.80	Professional	TC	$154.16	$180.53	$378.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.01 / $499.29 / $684.43	Professional		$301.01	$499.29	$684.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.59 / $173.84 / $248.99	Professional	26	$107.59	$173.84	$248.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.71 / $333.03 / $474.17	Professional	TC	$181.71	$333.03	$474.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $440.52 / $513.38 / $620.91	Professional		$440.52	$513.38	$620.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $153.21 / $181.30 / $209.21	Professional	26	$153.21	$181.30	$209.21
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $284.95 / $333.39 / $411.74	Professional	TC	$284.95	$333.39	$411.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $367.19 / $424.96 / $704.52	Professional		$367.19	$424.96	$704.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.16 / $167.99 / $256.76	Professional	26	$129.16	$167.99	$256.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $238.05 / $314.51 / $473.21	Professional	TC	$238.05	$314.51	$473.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $118.09 / $160.36 / $162.13	Facility	26	$118.09	$160.36	$162.13
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $97.28 / $145.93 / $184.53	Professional	26	$97.28	$145.93	$184.53
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $208.68 / $274.36 / $361.56	Professional	TC	$208.68	$274.36	$361.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $407.70 / $520.88 / $663.10	Professional		$407.70	$520.88	$663.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $110.53 / $179.41 / $234.16	Professional	26	$110.53	$179.41	$234.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $204.89 / $336.11 / $434.18	Professional	TC	$204.89	$336.11	$434.18
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 $434.93 / $543.23 / $656.62	Professional		$434.93	$543.23	$656.62
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $153.07 / $188.88 / $229.30	Professional	26	$153.07	$188.88	$229.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $278.16 / $354.35 / $427.32	Professional	TC	$278.16	$354.35	$427.32
United Facility/Professional Professional Modifier Low / Median / High Price $281.57 / $479.34 / $712.39	Professional		$281.57	$479.34	$712.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.93 / $164.57 / $250.14	Professional	26	$95.93	$164.57	$250.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.87 / $317.19 / $467.23	Professional	TC	$170.87	$317.19	$467.23