Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $183.33 / $209.28 / $422.93	Facility	26	$183.33	$209.28	$422.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $282.94 / $475.00 / $1,320.50	Professional		$282.94	$475.00	$1,320.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.57 / $140.00 / $453.00	Professional	26	$84.57	$140.00	$453.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $335.00 / $538.13	Professional	TC	$187.50	$335.00	$538.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.82 / $96.82 / $96.82	Facility	26	$96.82	$96.82	$96.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.45 / $574.10 / $925.30	Professional		$299.45	$574.10	$925.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.74 / $152.47 / $246.83	Professional	26	$83.74	$152.47	$246.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $426.22 / $700.73	Professional	TC	$214.01	$426.22	$700.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $542.38 / $616.91 / $744.35	Professional		$542.38	$616.91	$744.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $161.54 / $185.96 / $217.41	Professional	26	$161.54	$185.96	$217.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $375.86 / $431.91 / $526.94	Professional	TC	$375.86	$431.91	$526.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $465.87 / $625.59 / $1,009.92	Professional		$465.87	$625.59	$1,009.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.04 / $166.16 / $257.19	Professional	26	$135.04	$166.16	$257.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $304.23 / $433.29 / $876.68	Professional	TC	$304.23	$433.29	$876.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $125.44 / $166.51 / $171.52	Facility	26	$125.44	$166.51	$171.52
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $345.93	Professional		$268.35	$268.35	$345.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.91 / $149.91 / $182.16	Professional	26	$102.91	$149.91	$182.16
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $271.75 / $416.07 / $831.72	Professional	TC	$271.75	$416.07	$831.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.82 / $96.82 / $96.82	Facility	26	$96.82	$96.82	$96.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $459.40 / $664.56 / $851.01	Professional		$459.40	$664.56	$851.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.86 / $153.03 / $246.83	Professional	26	$86.86	$153.03	$246.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $418.37 / $700.73	Professional	TC	$214.01	$418.37	$700.73
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 $506.33 / $662.17 / $870.23	Professional		$506.33	$662.17	$870.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.41 / $180.41 / $239.72	Professional	26	$151.41	$180.41	$239.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.91 / $465.58 / $669.14	Professional	TC	$354.91	$465.58	$669.14
United Facility/Professional Professional Modifier Low / Median / High Price $268.11 / $453.50 / $900.07	Professional		$268.11	$453.50	$900.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $100.26 / $261.11	Professional	26	$77.62	$100.26	$261.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.49 / $372.59 / $635.89	Professional	TC	$190.49	$372.59	$635.89