Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.98 / $125.04 / $1,513.35	Facility	26	$89.98	$125.04	$1,513.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.67 / $424.11 / $1,248.25	Professional		$338.67	$424.11	$1,248.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.32 / $73.16 / $239.00	Professional	26	$51.32	$73.16	$239.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $287.33 / $361.50 / $867.62	Professional	TC	$287.33	$361.50	$867.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.88 / $63.88 / $63.88	Facility	26	$63.88	$63.88	$63.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $471.59 / $906.36 / $1,263.85	Professional		$471.59	$906.36	$1,263.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.87 / $111.47 / $159.40	Professional	26	$69.87	$111.47	$159.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $408.81 / $797.89 / $1,117.10	Professional	TC	$408.81	$797.89	$1,117.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $817.08 / $1,065.35 / $1,241.97	Professional		$817.08	$1,065.35	$1,241.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $98.02 / $127.80 / $144.19	Professional	26	$98.02	$127.80	$144.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $719.06 / $934.93 / $1,097.78	Professional	TC	$719.06	$934.93	$1,097.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $490.17 / $779.02 / $1,335.91	Professional		$490.17	$779.02	$1,335.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.55 / $99.35 / $176.14	Professional	26	$80.55	$99.35	$176.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $227.04 / $691.11 / $1,259.35	Professional	TC	$227.04	$691.11	$1,259.35
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $79.94 / $108.54 / $111.89	Facility	26	$79.94	$108.54	$111.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.00 / $86.04 / $113.85	Professional	26	$66.00	$86.04	$113.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $375.06 / $514.59 / $783.01	Professional	TC	$375.06	$514.59	$783.01
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $63.88 / $63.88 / $63.88	Facility	26	$63.88	$63.88	$63.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $564.34 / $918.08 / $1,220.97	Professional		$564.34	$918.08	$1,220.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.28 / $116.64 / $159.40	Professional	26	$71.28	$116.64	$159.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $408.81 / $834.16 / $1,126.73	Professional	TC	$408.81	$834.16	$1,126.73
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $680.75 / $884.45 / $1,257.33	Professional		$680.75	$884.45	$1,257.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.10 / $109.97 / $156.34	Professional	26	$89.10	$109.97	$156.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $596.11 / $774.47 / $1,100.99	Professional	TC	$596.11	$774.47	$1,100.99
United Facility/Professional Professional Modifier Low / Median / High Price $623.74 / $849.20 / $1,344.09	Professional		$623.74	$849.20	$1,344.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.91 / $119.30 / $170.93	Professional	26	$75.91	$119.30	$170.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $539.58 / $735.95 / $1,178.89	Professional	TC	$539.58	$735.95	$1,178.89