Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $191.95 / $424.76	Facility	26	$127.92	$191.95	$424.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.22 / $494.18 / $921.30	Professional		$288.22	$494.18	$921.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.90 / $129.72 / $506.45	Professional	26	$84.90	$129.72	$506.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $203.32 / $335.00 / $550.70	Professional	TC	$203.32	$335.00	$550.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $304.95 / $581.90 / $942.32	Professional		$304.95	$581.90	$942.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.10 / $152.63 / $247.81	Professional	26	$84.10	$152.63	$247.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.15 / $436.27 / $717.56	Professional	TC	$219.15	$436.27	$717.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $552.28 / $628.45 / $758.26	Professional		$552.28	$628.45	$758.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $162.19 / $186.70 / $218.35	Professional	26	$162.19	$186.70	$218.35
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $385.12 / $442.72 / $539.91	Professional	TC	$385.12	$442.72	$539.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $460.80 / $636.99 / $1,034.88	Professional		$460.80	$636.99	$1,034.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.56 / $175.56 / $258.20	Professional	26	$135.56	$175.56	$258.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $311.69 / $467.53 / $889.08	Professional	TC	$311.69	$467.53	$889.08
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $125.44 / $167.17 / $171.36	Facility	26	$125.44	$167.17	$171.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $110.15 / $147.07 / $179.56	Professional	26	$110.15	$147.07	$179.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $283.77 / $400.82 / $840.00	Professional	TC	$283.77	$400.82	$840.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.16 / $97.16 / $97.16	Facility	26	$97.16	$97.16	$97.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $465.95 / $677.04 / $865.83	Professional		$465.95	$677.04	$865.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.81 / $152.63 / $247.81	Professional	26	$85.81	$152.63	$247.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $219.15 / $426.00 / $717.56	Professional	TC	$219.15	$426.00	$717.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,538.06 / $1,538.06 / $1,538.06	Facility	26	$1,538.06	$1,538.06	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $515.30 / $673.71 / $900.36	Professional		$515.30	$673.71	$900.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $152.02 / $180.41 / $240.67	Professional	26	$152.02	$180.41	$240.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $363.29 / $475.07 / $684.94	Professional	TC	$363.29	$475.07	$684.94
United Facility/Professional Professional Modifier Low / Median / High Price $272.41 / $544.82 / $917.85	Professional		$272.41	$544.82	$917.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.89 / $113.29 / $262.14	Professional	26	$77.89	$113.29	$262.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.49 / $359.51 / $654.29	Professional	TC	$194.49	$359.51	$654.29