Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $158.05 / $350.61	Facility	26	$127.92	$158.05	$350.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.16 / $494.18 / $924.53	Professional		$342.16	$494.18	$924.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.42 / $140.00 / $409.25	Professional	26	$71.42	$140.00	$409.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $271.81 / $352.08 / $746.43	Professional	TC	$271.81	$352.08	$746.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $367.68 / $846.85 / $1,332.47	Professional		$367.68	$846.85	$1,332.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.83 / $127.90 / $204.54	Professional	26	$70.83	$127.90	$204.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $296.85 / $702.52 / $1,127.51	Professional	TC	$296.85	$702.52	$1,127.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $662.12 / $745.68 / $914.97	Professional		$662.12	$745.68	$914.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $133.09 / $153.88 / $179.04	Professional	26	$133.09	$153.88	$179.04
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $524.92 / $595.90 / $735.94	Professional	TC	$524.92	$595.90	$735.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $552.09 / $800.12 / $1,470.42	Professional		$552.09	$800.12	$1,470.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.01 / $157.50 / $212.46	Professional	26	$111.01	$157.50	$212.46
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $424.84 / $605.08 / $1,425.38	Professional	TC	$424.84	$605.08	$1,425.38
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.32 / $137.19 / $172.19	Facility	26	$114.32	$137.19	$172.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $97.71 / $142.47 / $174.40	Professional	26	$97.71	$142.47	$174.40
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $439.92 / $800.40 / $1,312.54	Professional	TC	$439.92	$800.40	$1,312.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $586.83 / $847.94 / $1,213.27	Professional		$586.83	$847.94	$1,213.27
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.17 / $128.38 / $204.54	Professional	26	$72.17	$128.38	$204.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $300.30 / $682.50 / $1,119.11	Professional	TC	$300.30	$682.50	$1,119.11
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 $615.86 / $832.56 / $1,255.28	Professional		$615.86	$832.56	$1,255.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.09 / $157.38 / $198.03	Professional	26	$125.09	$157.38	$198.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $490.77 / $664.60 / $1,000.32	Professional	TC	$490.77	$664.60	$1,000.32
United Facility/Professional Professional Modifier Low / Median / High Price $320.88 / $627.61 / $1,138.58	Professional		$320.88	$627.61	$1,138.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.73 / $96.66 / $217.75	Professional	26	$64.73	$96.66	$217.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $256.14 / $501.00 / $907.34	Professional	TC	$256.14	$501.00	$907.34