Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.46 / $82.46 / $90.35	Facility	26	$82.46	$82.46	$90.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $263.77 / $299.41 / $674.36	Professional		$263.77	$299.41	$674.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.67 / $40.90 / $56.38	Professional	26	$35.67	$40.90	$56.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.02 / $252.75 / $392.28	Professional	TC	$218.02	$252.75	$392.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $294.89 / $543.26 / $774.74	Professional		$294.89	$543.26	$774.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.59 / $76.11 / $113.18	Professional	26	$41.59	$76.11	$113.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $253.68 / $467.15 / $661.56	Professional	TC	$253.68	$467.15	$661.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $469.92 / $547.64 / $671.63	Professional		$469.92	$547.64	$671.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.90 / $81.87 / $94.09	Professional	26	$68.90	$81.87	$94.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $399.67 / $467.64 / $577.54	Professional	TC	$399.67	$467.64	$577.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $393.89 / $472.32 / $783.00	Professional		$393.89	$472.32	$783.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.31 / $77.06 / $119.88	Professional	26	$60.31	$77.06	$119.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $333.58 / $438.71 / $663.12	Professional	TC	$333.58	$438.71	$663.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.84 / $72.41 / $74.37	Facility	26	$48.84	$72.41	$74.37
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $122.90 / $240.84 / $240.84	Professional		$122.90	$240.84	$240.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.62 / $61.05 / $74.37	Professional	26	$44.62	$61.05	$74.37
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $329.60 / $411.97 / $423.44	Professional	TC	$329.60	$411.97	$423.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $465.14 / $573.62 / $733.20	Professional		$465.14	$573.62	$733.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $80.13 / $105.13	Professional	26	$50.74	$80.13	$105.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $289.41 / $477.31 / $630.76	Professional	TC	$289.41	$477.31	$630.76
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $785.39 / $785.39 / $785.39	Facility	26	$785.39	$785.39	$785.39
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $471.09 / $601.97 / $722.13	Professional		$471.09	$601.97	$722.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.92 / $90.62 / $106.12	Professional	26	$70.92	$90.62	$106.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $400.17 / $511.35 / $616.64	Professional	TC	$400.17	$511.35	$616.64
United Facility/Professional Professional Modifier Low / Median / High Price $279.48 / $512.03 / $778.29	Professional		$279.48	$512.03	$778.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.61 / $77.00 / $113.70	Professional	26	$43.61	$77.00	$113.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $244.33 / $444.94 / $658.41	Professional	TC	$244.33	$444.94	$658.41