Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $208.90 / $227.63 / $270.06	Facility	26	$208.90	$227.63	$270.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.81 / $495.09 / $1,569.00	Professional		$339.81	$495.09	$1,569.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.56 / $135.03 / $418.82	Professional	26	$101.56	$135.03	$418.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $170.00 / $283.67 / $326.69	Professional	52	$170.00	$283.67	$326.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $206.93 / $313.64 / $657.26	Professional	TC	$206.93	$313.64	$657.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $471.37 / $847.19 / $1,072.86	Professional		$471.37	$847.19	$1,072.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $151.88 / $232.04 / $335.65	Professional	26	$151.88	$232.04	$335.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $319.48 / $605.46 / $772.94	Professional	TC	$319.48	$605.46	$772.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $557.78 / $794.36 / $918.19	Professional		$557.78	$794.36	$918.19
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $164.17 / $232.02 / $261.24	Professional	26	$164.17	$232.02	$261.24
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $399.10 / $559.49 / $656.98	Professional	TC	$399.10	$559.49	$656.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $483.60 / $575.12 / $1,077.94	Professional		$483.60	$575.12	$1,077.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $163.32 / $232.60 / $324.64	Professional	26	$163.32	$232.60	$324.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $378.94 / $539.70 / $753.28	Professional	TC	$378.94	$539.70	$753.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $146.32 / $199.99 / $204.68	Facility	26	$146.32	$199.99	$204.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $317.18 / $317.18 / $352.43	Professional		$317.18	$317.18	$352.43
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $121.40 / $189.99 / $217.44	Professional	26	$121.40	$189.99	$217.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $265.42 / $370.95 / $526.62	Professional	TC	$265.42	$370.95	$526.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $570.33 / $867.35 / $1,072.86	Professional		$570.33	$867.35	$1,072.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $159.22 / $232.04 / $299.93	Professional	26	$159.22	$232.04	$299.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $334.92 / $605.46 / $772.94	Professional	TC	$334.92	$605.46	$772.94
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,906.19 / $1,906.19 / $1,906.19	Facility	26	$1,906.19	$1,906.19	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $672.85 / $895.17 / $1,144.46	Professional		$672.85	$895.17	$1,144.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $186.97 / $250.25 / $319.95	Professional	26	$186.97	$250.25	$319.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $485.88 / $644.91 / $824.51	Professional	TC	$485.88	$644.91	$824.51
United Facility/Professional Professional Modifier Low / Median / High Price $520.01 / $674.12 / $1,163.92	Professional		$520.01	$674.12	$1,163.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $160.06 / $219.00 / $323.44	Professional	26	$160.06	$219.00	$323.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $362.97 / $515.48 / $832.66	Professional	TC	$362.97	$515.48	$832.66