Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $209.61 / $423.18	Facility	26	$127.92	$209.61	$423.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $366.73 / $494.18 / $1,043.97	Professional		$366.73	$494.18	$1,043.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.12 / $140.00 / $409.65	Professional	26	$87.12	$140.00	$409.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $280.01 / $356.78 / $717.81	Professional	TC	$280.01	$356.78	$717.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $370.96 / $711.68 / $1,100.29	Professional		$370.96	$711.68	$1,100.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.57 / $152.72 / $246.83	Professional	26	$83.57	$152.72	$246.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $285.47 / $557.72 / $852.43	Professional	TC	$285.47	$557.72	$852.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $668.15 / $761.80 / $920.48	Professional		$668.15	$761.80	$920.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $161.36 / $186.56 / $216.97	Professional	26	$161.36	$186.56	$216.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $501.82 / $575.23 / $703.51	Professional	TC	$501.82	$575.23	$703.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $570.15 / $705.84 / $1,061.33	Professional		$570.15	$705.84	$1,061.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.49 / $169.72 / $258.20	Professional	26	$134.49	$169.72	$258.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $406.16 / $578.48 / $807.40	Professional	TC	$406.16	$578.48	$807.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $124.95 / $166.34 / $171.52	Facility	26	$124.95	$166.34	$171.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.91 / $152.19 / $178.89	Professional	26	$102.91	$152.19	$178.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $367.83 / $549.00 / $795.76	Professional	TC	$367.83	$549.00	$795.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.95 / $96.95 / $96.95	Facility	26	$96.95	$96.95	$96.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $568.32 / $821.51 / $1,035.23	Professional		$568.32	$821.51	$1,035.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.55 / $154.32 / $246.83	Professional	26	$87.55	$154.32	$246.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $285.47 / $557.72 / $853.90	Professional	TC	$285.47	$557.72	$853.90
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $624.83 / $813.91 / $1,007.44	Professional		$624.83	$813.91	$1,007.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $152.02 / $179.71 / $240.67	Professional	26	$152.02	$179.71	$240.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $472.82 / $620.74 / $783.51	Professional	TC	$472.82	$620.74	$783.51
United Facility/Professional Professional Modifier Low / Median / High Price $331.61 / $493.41 / $1,110.70	Professional		$331.61	$493.41	$1,110.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.92 / $110.61 / $262.54	Professional	26	$77.92	$110.61	$262.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.69 / $380.79 / $853.46	Professional	TC	$253.69	$380.79	$853.46