Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $212.80 / $232.00 / $257.77	Facility	26	$212.80	$232.00	$257.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.74 / $506.07 / $1,876.56	Professional		$342.74	$506.07	$1,876.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.84 / $137.65 / $560.90	Professional	26	$53.84	$137.65	$560.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $207.65 / $368.42 / $1,315.67	Professional	TC	$207.65	$368.42	$1,315.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $462.29 / $835.88 / $1,079.75	Professional		$462.29	$835.88	$1,079.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $154.38 / $236.71 / $345.19	Professional	26	$154.38	$236.71	$345.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $307.91 / $604.67 / $771.95	Professional	TC	$307.91	$604.67	$771.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $559.75 / $797.60 / $921.44	Professional		$559.75	$797.60	$921.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $167.21 / $236.54 / $266.32	Professional	26	$167.21	$236.54	$266.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $397.97 / $557.92 / $655.11	Professional	TC	$397.97	$557.92	$655.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $484.20 / $577.96 / $1,083.25	Professional		$484.20	$577.96	$1,083.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $167.05 / $237.91 / $332.07	Professional	26	$167.05	$237.91	$332.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $377.87 / $538.16 / $751.15	Professional	TC	$377.87	$538.16	$751.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $149.71 / $203.70 / $209.71	Facility	26	$149.71	$203.70	$209.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $306.95 / $306.95 / $306.95	Professional		$306.95	$306.95	$306.95
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $141.36 / $195.06 / $234.85	Professional	26	$141.36	$195.06	$234.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $275.52 / $372.24 / $525.95	Professional	TC	$275.52	$372.24	$525.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $572.26 / $868.00 / $1,079.75	Professional		$572.26	$868.00	$1,079.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $161.85 / $238.46 / $307.80	Professional	26	$161.85	$238.46	$307.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $322.79 / $604.67 / $771.95	Professional	TC	$322.79	$604.67	$771.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,906.19 / $1,906.19 / $1,906.19	Facility	26	$1,906.19	$1,906.19	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $674.69 / $900.91 / $1,151.80	Professional		$674.69	$900.91	$1,151.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $191.27 / $256.82 / $328.34	Professional	26	$191.27	$256.82	$328.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $483.42 / $644.09 / $823.47	Professional	TC	$483.42	$644.09	$823.47
United Facility/Professional Professional Modifier Low / Median / High Price $523.65 / $818.57 / $1,167.08	Professional		$523.65	$818.57	$1,167.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $163.25 / $227.47 / $330.88	Professional	26	$163.25	$227.47	$330.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $353.60 / $476.00 / $836.21	Professional	TC	$353.60	$476.00	$836.21