Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $436.52 / $467.74	Facility	26	$239.88	$436.52	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $331.13 / $870.96	Professional		$275.42	$331.13	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $204.17 / $524.81	Professional	26	$169.82	$204.17	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $117.49 / $213.80	Professional	TC	$97.72	$117.49	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $562.34 / $831.76	Professional		$316.23	$562.34	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $346.74 / $524.81	Professional	26	$204.17	$346.74	$524.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $316.23	Professional	TC	$117.49	$208.93	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $645.65 / $758.58	Professional		$537.03	$645.65	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $338.84 / $407.38 / $478.63	Professional	26	$338.84	$407.38	$478.63
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $257.04 / $288.40	Professional	TC	$199.53	$257.04	$288.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $562.34 / $758.58	Professional		$331.13	$562.34	$758.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $371.54 / $549.54	Professional	26	$190.55	$371.54	$549.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $213.80 / $302.00	Professional	TC	$117.49	$213.80	$302.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $363.08 / $363.08	Facility	26	$302.00	$363.08	$363.08
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $302.00 / $389.05	Professional	26	$218.78	$302.00	$389.05
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $181.97 / $223.87	Professional	TC	$131.83	$181.97	$223.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $602.56 / $812.83	Professional		$416.87	$602.56	$812.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $354.81 / $524.81	Professional	26	$234.42	$354.81	$524.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $213.80 / $302.00	Professional	TC	$138.04	$213.80	$302.00
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility	26	$1,513.56	$1,513.56	$1,513.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $588.84 / $776.25	Professional		$457.09	$588.84	$776.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $371.54 / $489.78	Professional	26	$295.12	$371.54	$489.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $218.78 / $281.84	Professional	TC	$165.96	$218.78	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $602.56 / $870.96	Professional		$363.08	$602.56	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $371.54 / $549.54	Professional	26	$234.42	$371.54	$549.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $223.87 / $323.59	Professional	TC	$134.90	$223.87	$323.59