Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $192.47 / $425.16	Facility	26	$127.92	$192.47	$425.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $365.25 / $494.18 / $1,459.50	Professional		$365.25	$494.18	$1,459.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.04 / $140.00 / $510.42	Professional	26	$94.04	$140.00	$510.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $273.45 / $353.41 / $750.13	Professional	TC	$273.45	$353.41	$750.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.25 / $97.25 / $97.25	Facility	26	$97.25	$97.25	$97.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $384.21 / $880.44 / $1,361.80	Professional		$384.21	$880.44	$1,361.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.95 / $153.21 / $247.81	Professional	26	$83.95	$153.21	$247.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $298.32 / $706.00 / $1,135.28	Professional	TC	$298.32	$706.00	$1,135.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $693.89 / $782.64 / $956.67	Professional		$693.89	$782.64	$956.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $162.01 / $187.24 / $217.96	Professional	26	$162.01	$187.24	$217.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $526.91 / $598.15 / $738.71	Professional	TC	$526.91	$598.15	$738.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $578.49 / $840.72 / $1,474.20	Professional		$578.49	$840.72	$1,474.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.04 / $170.40 / $259.23	Professional	26	$135.04	$170.40	$259.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $426.44 / $607.36 / $1,424.76	Professional	TC	$426.44	$607.36	$1,424.76
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $125.93 / $166.99 / $172.19	Facility	26	$125.93	$166.99	$172.19
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $298.17 / $298.17 / $298.17	Professional		$298.17	$298.17	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.91 / $153.16 / $187.61	Professional	26	$102.91	$153.16	$187.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $439.42 / $821.94 / $1,336.35	Professional	TC	$439.42	$821.94	$1,336.35
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.25 / $97.25 / $97.25	Facility	26	$97.25	$97.25	$97.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $614.36 / $886.88 / $1,261.51	Professional		$614.36	$886.88	$1,261.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.90 / $153.71 / $247.81	Professional	26	$87.90	$153.71	$247.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $301.77 / $685.73 / $1,124.65	Professional	TC	$301.77	$685.73	$1,124.65
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 $645.78 / $873.02 / $1,265.75	Professional		$645.78	$873.02	$1,265.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $152.62 / $181.12 / $241.61	Professional	26	$152.62	$181.12	$241.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $493.16 / $667.89 / $1,005.20	Professional	TC	$493.16	$667.89	$1,005.20
United Facility/Professional Professional Modifier Low / Median / High Price $336.52 / $656.54 / $1,147.94	Professional		$336.52	$656.54	$1,147.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.50 / $100.66 / $264.17	Professional	26	$78.50	$100.66	$264.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.98 / $546.64 / $911.75	Professional	TC	$257.98	$546.64	$911.75