Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $234.42 / $263.03	Facility	26	$138.04	$234.42	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $407.38 / $851.14	Professional		$338.84	$407.38	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $128.82 / $263.03	Professional	26	$104.71	$128.82	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $275.42 / $602.56	Professional	TC	$229.09	$275.42	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $831.76 / $1,096.48	Professional		$416.87	$831.76	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $239.88 / $346.74	Professional	26	$120.23	$239.88	$346.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $602.56 / $776.25	Professional	TC	$269.15	$602.56	$776.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $707.95 / $912.01	Professional		$537.03	$707.95	$912.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $218.78 / $269.15	Professional	26	$169.82	$218.78	$269.15
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $478.63 / $645.65	Professional	TC	$371.54	$478.63	$645.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $575.44 / $954.99	Professional		$489.78	$575.44	$954.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $213.80 / $331.13	Professional	26	$158.49	$213.80	$331.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $489.78 / $758.58	Professional	TC	$338.84	$489.78	$758.58
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $204.17 / $208.93	Facility	26	$173.78	$204.17	$208.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $186.21 / $223.87	Professional	26	$123.03	$186.21	$223.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $338.84 / $467.74	Professional	TC	$251.19	$338.84	$467.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $758.58 / $1,000.00	Professional		$489.78	$758.58	$1,000.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $213.80 / $309.03	Professional	26	$144.54	$213.80	$309.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $501.19 / $724.44	Professional	TC	$281.84	$501.19	$724.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,905.46 / $1,905.46 / $1,905.46	Facility	26	$1,905.46	$1,905.46	$1,905.46
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $794.33 / $1,000.00	Professional		$676.08	$794.33	$1,000.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $223.87 / $281.84	Professional	26	$199.53	$223.87	$281.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $575.44 / $724.44	Professional	TC	$478.63	$575.44	$724.44
United Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $645.65 / $977.24	Professional		$398.11	$645.65	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $208.93 / $295.12	Professional	26	$141.25	$208.93	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $426.58 / $691.83	Professional	TC	$251.19	$426.58	$691.83