Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $208.74 / $421.79	Facility	26	$127.92	$208.74	$421.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $296.33 / $488.59 / $1,742.69	Professional		$296.33	$488.59	$1,742.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.29 / $140.00 / $322.00	Professional	26	$85.29	$140.00	$322.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $237.50 / $384.62	Professional	52	$125.00	$237.50	$384.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $209.94 / $335.00 / $538.13	Professional	TC	$209.94	$335.00	$538.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.22 / $571.08 / $924.60	Professional		$299.22	$571.08	$924.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.30 / $152.02 / $245.84	Professional	26	$83.30	$152.02	$245.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $428.47 / $700.73	Professional	TC	$214.01	$428.47	$700.73
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $543.49 / $614.04 / $745.98	Professional		$543.49	$614.04	$745.98
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $160.69 / $185.00 / $216.27	Professional	26	$160.69	$185.00	$216.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $377.85 / $429.04 / $529.72	Professional	TC	$377.85	$429.04	$529.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $453.12 / $626.37 / $1,018.88	Professional		$453.12	$626.37	$1,018.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $133.96 / $166.16 / $257.19	Professional	26	$133.96	$166.16	$257.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $305.83 / $435.57 / $876.68	Professional	TC	$305.83	$435.57	$876.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $124.46 / $165.65 / $170.85	Facility	26	$124.46	$165.65	$170.85
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $298.17 / $376.90	Professional		$268.35	$298.17	$376.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $110.25 / $153.00 / $186.15	Professional	26	$110.25	$153.00	$186.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $292.00 / $414.37 / $818.85	Professional	TC	$292.00	$414.37	$818.85
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $457.24 / $661.44 / $846.15	Professional		$457.24	$661.44	$846.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.86 / $153.03 / $245.84	Professional	26	$86.86	$153.03	$245.84
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $328.35 / $328.35 / $328.35	Professional	52	$328.35	$328.35	$328.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $214.01 / $415.82 / $700.73	Professional	TC	$214.01	$415.82	$700.73
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $506.33 / $661.39 / $882.53	Professional		$506.33	$661.39	$882.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.41 / $179.71 / $239.72	Professional	26	$151.41	$179.71	$239.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.91 / $461.93 / $669.14	Professional	TC	$354.91	$461.93	$669.14
United Facility/Professional Professional Modifier Low / Median / High Price $266.58 / $487.97 / $898.20	Professional		$266.58	$487.97	$898.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $108.48 / $261.11	Professional	26	$77.62	$108.48	$261.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $369.59 / $635.70	Professional	TC	$188.96	$369.59	$635.70