Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.90 / $208.00 / $384.86	Facility	26	$173.90	$208.00	$384.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.27 / $494.18 / $2,073.69	Professional		$331.27	$494.18	$2,073.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $140.00 / $404.00	Professional	26	$73.00	$140.00	$404.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $253.56 / $348.17 / $684.23	Professional	TC	$253.56	$348.17	$684.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.95 / $87.95 / $87.95	Facility	26	$87.95	$87.95	$87.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $349.04 / $682.39 / $1,051.69	Professional		$349.04	$682.39	$1,051.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.05 / $138.88 / $224.21	Professional	26	$76.05	$138.88	$224.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $271.27 / $539.36 / $826.19	Professional	TC	$271.27	$539.36	$826.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $626.79 / $722.09 / $864.24	Professional		$626.79	$722.09	$864.24
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $146.66 / $169.96 / $197.45	Professional	26	$146.66	$169.96	$197.45
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $475.62 / $552.11 / $666.82	Professional	TC	$475.62	$552.11	$666.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $522.39 / $670.00 / $1,007.91	Professional		$522.39	$670.00	$1,007.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $122.22 / $158.28 / $233.82	Professional	26	$122.22	$158.28	$233.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $384.81 / $548.07 / $861.80	Professional	TC	$384.81	$548.07	$861.80
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $113.68 / $151.19 / $156.11	Facility	26	$113.68	$151.19	$156.11
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $397.94 / $397.94 / $409.50	Professional		$397.94	$397.94	$409.50
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $147.61 / $173.25	Professional	26	$93.26	$147.61	$173.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $340.00 / $535.33 / $717.42	Professional	TC	$340.00	$535.33	$717.42
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $87.95 / $87.95 / $87.95	Facility	26	$87.95	$87.95	$87.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $531.45 / $779.22 / $982.13	Professional		$531.45	$779.22	$982.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.56 / $140.30 / $224.34	Professional	26	$79.56	$140.30	$224.34
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $271.27 / $539.36 / $826.19	Professional	TC	$271.27	$539.36	$826.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,298.07 / $2,298.07 / $2,298.07	Facility	26	$2,298.07	$2,298.07	$2,298.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $588.91 / $769.33 / $946.80	Professional		$588.91	$769.33	$946.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $137.66 / $164.14 / $217.93	Professional	26	$137.66	$164.14	$217.93
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $451.27 / $593.33 / $766.24	Professional	TC	$451.27	$593.33	$766.24
United Facility/Professional Professional Modifier Low / Median / High Price $316.27 / $483.70 / $1,050.86	Professional		$316.27	$483.70	$1,050.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.17 / $102.56 / $239.80	Professional	26	$71.17	$102.56	$239.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.10 / $374.85 / $818.16	Professional	TC	$245.10	$374.85	$818.16