Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $250.19 / $250.19 / $276.83	Facility	26	$250.19	$250.19	$276.83
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $335.10 / $335.10 / $366.65	Facility	53	$335.10	$335.10	$366.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $761.62 / $1,151.25 / $4,359.00	Professional		$761.62	$1,151.25	$4,359.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.52 / $198.60 / $680.92	Professional	26	$112.52	$198.60	$680.92
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $345.55 / $477.68 / $1,001.11	Professional	52	$345.55	$477.68	$1,001.11
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $138.22 / $190.92 / $400.44	Professional	53	$138.22	$190.92	$400.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $614.24 / $813.10 / $1,686.24	Professional	TC	$614.24	$813.10	$1,686.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,010.99 / $1,672.16 / $2,388.30	Professional		$1,010.99	$1,672.16	$2,388.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $173.51 / $245.69 / $355.77	Professional	26	$173.51	$245.69	$355.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $807.66 / $1,402.27 / $2,049.54	Professional	TC	$807.66	$1,402.27	$2,049.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,380.54 / $1,644.70 / $1,915.68	Professional		$1,380.54	$1,644.70	$1,915.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $212.20 / $254.20 / $286.64	Professional	26	$212.20	$254.20	$286.64
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,161.80 / $1,387.23 / $1,629.02	Professional	TC	$1,161.80	$1,387.23	$1,629.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,148.72 / $1,573.74 / $2,216.36	Professional		$1,148.72	$1,573.74	$2,216.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $176.12 / $250.84 / $350.11	Professional	26	$176.12	$250.84	$350.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $938.80 / $1,321.32 / $1,866.22	Professional	TC	$938.80	$1,321.32	$1,866.22
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $181.43 / $221.10 / $351.08	Facility	26	$181.43	$221.10	$351.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $158.11 / $269.33 / $372.88	Professional	26	$158.11	$269.33	$372.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $832.54 / $1,120.05 / $1,459.93	Professional	TC	$832.54	$1,120.05	$1,459.93
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,371.53 / $1,758.40 / $2,290.78	Professional		$1,371.53	$1,758.40	$2,290.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $153.30 / $251.59 / $371.59	Professional	26	$153.30	$251.59	$371.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $906.00 / $1,484.22 / $2,068.23	Professional	TC	$906.00	$1,484.22	$2,068.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,505.71 / $2,505.71 / $2,505.71	Facility	26	$2,505.71	$2,505.71	$2,505.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,407.07 / $1,706.80 / $2,127.02	Professional		$1,407.07	$1,706.80	$2,127.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $208.09 / $262.20 / $350.99	Professional	26	$208.09	$262.20	$350.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,195.05 / $1,425.91 / $1,824.20	Professional	TC	$1,195.05	$1,425.91	$1,824.20
United Facility/Professional Professional Modifier Low / Median / High Price $879.50 / $1,675.53 / $2,478.62	Professional		$879.50	$1,675.53	$2,478.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.09 / $264.01 / $382.90	Professional	26	$132.09	$264.01	$382.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,425.87 / $2,106.77	Professional	TC	$747.41	$1,425.87	$2,106.77