Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.28 / $106.90 / $134.33	Facility	26	$70.28	$106.90	$134.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $246.93 / $306.55 / $1,126.00	Professional		$246.93	$306.55	$1,126.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.72 / $106.00 / $372.50	Professional	26	$58.72	$106.00	$372.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $222.61 / $526.96	Professional	TC	$162.34	$222.61	$526.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $352.99 / $599.79 / $883.63	Professional		$352.99	$599.79	$883.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.73 / $121.11 / $188.34	Professional	26	$76.73	$121.11	$188.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $286.55 / $477.31 / $691.29	Professional	TC	$286.55	$477.31	$691.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $498.92 / $581.42 / $710.49	Professional		$498.92	$581.42	$710.49
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.43 / $120.16 / $138.51	Professional	26	$101.43	$120.16	$138.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $395.83 / $463.14 / $571.98	Professional	TC	$395.83	$463.14	$571.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $416.84 / $550.48 / $811.26	Professional		$416.84	$550.48	$811.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.46 / $115.28 / $171.87	Professional	26	$86.46	$115.28	$171.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $330.36 / $438.03 / $656.72	Professional	TC	$330.36	$438.03	$656.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.00 / $106.27 / $165.10	Facility	26	$89.00	$106.27	$165.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.00 / $110.55 / $169.62	Professional	26	$66.00	$110.55	$169.62
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $257.20 / $415.40 / $510.41	Professional	TC	$257.20	$415.40	$510.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $493.29 / $624.79 / $793.77	Professional		$493.29	$624.79	$793.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $73.84 / $122.48 / $179.31	Professional	26	$73.84	$122.48	$179.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $298.02 / $487.09 / $636.97	Professional	TC	$298.02	$487.09	$636.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $505.28 / $650.66 / $756.10	Professional		$505.28	$650.66	$756.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.73 / $132.91 / $158.05	Professional	26	$103.73	$132.91	$158.05
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $401.43 / $509.83 / $600.72	Professional	TC	$401.43	$509.83	$600.72
United Facility/Professional Professional Modifier Low / Median / High Price $319.89 / $548.10 / $826.73	Professional		$319.89	$548.10	$826.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.38 / $118.26 / $181.57	Professional	26	$66.38	$118.26	$181.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $283.27 / $435.05 / $668.59	Professional	TC	$283.27	$435.05	$668.59