Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $218.75 / $502.47	Facility	26	$127.92	$218.75	$502.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $334.70 / $498.46 / $1,786.57	Professional		$334.70	$498.46	$1,786.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $165.71 / $585.60	Professional	26	$104.00	$165.71	$585.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.82 / $335.00 / $855.39	Professional	TC	$239.82	$335.00	$855.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $353.46 / $709.59 / $1,157.32	Professional		$353.46	$709.59	$1,157.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.54 / $197.91 / $315.89	Professional	26	$107.54	$197.91	$315.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $243.75 / $489.73 / $873.85	Professional	TC	$243.75	$489.73	$873.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $641.91 / $729.91 / $879.33	Professional		$641.91	$729.91	$879.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $207.48 / $238.84 / $279.20	Professional	26	$207.48	$238.84	$279.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $428.06 / $492.37 / $600.13	Professional	TC	$428.06	$492.37	$600.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $535.59 / $740.37 / $1,238.49	Professional		$535.59	$740.37	$1,238.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.46 / $229.18 / $329.37	Professional	26	$173.46	$229.18	$329.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $346.38 / $493.34 / $1,220.07	Professional	TC	$346.38	$493.34	$1,220.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $160.22 / $213.86 / $219.91	Facility	26	$160.22	$213.86	$219.91
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 $135.79 / $208.64 / $254.51	Professional	26	$135.79	$208.64	$254.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $315.17 / $497.84 / $973.84	Professional	TC	$315.17	$497.84	$973.84
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $539.24 / $784.67 / $1,011.68	Professional		$539.24	$784.67	$1,011.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $111.43 / $198.59 / $316.64	Professional	26	$111.43	$198.59	$316.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $243.75 / $478.18 / $798.10	Professional	TC	$243.75	$478.18	$798.10
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 $599.10 / $784.48 / $1,034.43	Professional		$599.10	$784.48	$1,034.43
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 $405.18 / $531.42 / $763.93	Professional	TC	$405.18	$531.42	$763.93
United Facility/Professional Professional Modifier Low / Median / High Price $317.50 / $538.20 / $1,069.79	Professional		$317.50	$538.20	$1,069.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.57 / $128.63 / $335.40	Professional	26	$99.57	$128.63	$335.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.80 / $324.86 / $733.87	Professional	TC	$217.80	$324.86	$733.87