Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.00 / $214.46 / $436.05	Facility	26	$104.00	$214.46	$436.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $332.46 / $494.18 / $1,972.45	Professional		$332.46	$494.18	$1,972.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.46 / $180.14 / $518.00	Professional	26	$106.46	$180.14	$518.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $139.31 / $237.50 / $442.07	Professional	52	$139.31	$237.50	$442.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $249.38 / $355.51 / $925.25	Professional	TC	$249.38	$355.51	$925.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $351.62 / $702.73 / $1,151.31	Professional		$351.62	$702.73	$1,151.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.19 / $194.45 / $315.66	Professional	26	$107.19	$194.45	$315.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $242.28 / $485.82 / $870.53	Professional	TC	$242.28	$485.82	$870.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $639.92 / $724.97 / $876.55	Professional		$639.92	$724.97	$876.55
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $206.84 / $238.10 / $278.29	Professional	26	$206.84	$238.10	$278.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $426.73 / $487.43 / $598.28	Professional	TC	$426.73	$487.43	$598.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $533.94 / $738.09 / $1,237.76	Professional		$533.94	$738.09	$1,237.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $172.92 / $217.05 / $329.37	Professional	26	$172.92	$217.05	$329.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $345.31 / $491.81 / $1,244.85	Professional	TC	$345.31	$491.81	$1,244.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $160.22 / $213.20 / $219.09	Facility	26	$160.22	$213.20	$219.09
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 $131.05 / $201.00 / $232.49	Professional	26	$131.05	$201.00	$232.49
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $314.77 / $477.75 / $1,121.58	Professional	TC	$314.77	$477.75	$1,121.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $537.57 / $780.69 / $1,006.55	Professional		$537.57	$780.69	$1,006.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $111.43 / $198.24 / $315.66	Professional	26	$111.43	$198.24	$315.66
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $387.59 / $387.59 / $387.59	Professional	52	$387.59	$387.59	$387.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $242.28 / $474.36 / $793.29	Professional	TC	$242.28	$474.36	$793.29
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 $596.11 / $780.64 / $1,033.82	Professional		$596.11	$780.64	$1,033.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $193.91 / $229.94 / $306.99	Professional	26	$193.91	$229.94	$306.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $402.19 / $526.25 / $758.28	Professional	TC	$402.19	$526.25	$758.28
United Facility/Professional Professional Modifier Low / Median / High Price $315.04 / $604.80 / $1,102.08	Professional		$315.04	$604.80	$1,102.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.57 / $128.22 / $335.92	Professional	26	$99.57	$128.22	$335.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $215.34 / $407.11 / $725.59	Professional	TC	$215.34	$407.11	$725.59