Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $323.59 / $398.11	Facility	26	$194.98	$323.59	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $457.09 / $1,174.90	Professional		$316.23	$457.09	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $158.49 / $426.58	Professional	26	$131.83	$158.49	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $707.95	Professional	TC	$186.21	$288.40	$707.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $933.25 / $1,348.96	Professional		$645.65	$933.25	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $323.59 / $446.68	Professional	26	$213.80	$323.59	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $588.84 / $912.01	Professional	TC	$436.52	$588.84	$912.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $1,071.52 / $1,288.25	Professional		$501.19	$1,071.52	$1,288.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $346.74 / $407.38	Professional	26	$158.49	$346.74	$407.38
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $724.44 / $870.96	Professional	TC	$346.74	$724.44	$870.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $933.25 / $1,513.56	Professional		$575.44	$933.25	$1,513.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $346.74 / $489.78	Professional	26	$190.55	$346.74	$489.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $707.95 / $977.24	Professional	TC	$316.23	$707.95	$977.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $288.40 / $302.00	Facility	26	$245.47	$288.40	$302.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $251.19 / $302.00	Professional	26	$177.83	$251.19	$302.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $512.86 / $616.60	Professional	TC	$288.40	$512.86	$616.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $912.01 / $1,348.96	Professional		$588.84	$912.01	$1,348.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $316.23 / $446.68	Professional	26	$213.80	$316.23	$446.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $575.44 / $891.25	Professional	TC	$338.84	$575.44	$891.25
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility	26	$1,096.48	$1,096.48	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $891.25 / $1,202.26	Professional		$630.96	$891.25	$1,202.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $316.23 / $407.38	Professional	26	$269.15	$316.23	$407.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $575.44 / $794.33	Professional	TC	$363.08	$575.44	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $524.81 / $1,202.26	Professional		$446.68	$524.81	$1,202.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $194.98 / $436.52	Professional	26	$190.55	$194.98	$436.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $323.59 / $794.33	Professional	TC	$257.04	$323.59	$794.33