Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $235.17 / $502.47	Facility	26	$127.92	$235.17	$502.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $335.03 / $494.18 / $1,459.50	Professional		$335.03	$494.18	$1,459.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $168.21 / $606.00	Professional	26	$104.00	$168.21	$606.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.63 / $348.53 / $633.00	Professional	TC	$229.63	$348.53	$633.00
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 $354.19 / $695.22 / $1,136.80	Professional		$354.19	$695.22	$1,136.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.54 / $194.45 / $316.64	Professional	26	$107.54	$194.45	$316.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $244.48 / $486.91 / $800.51	Professional	TC	$244.48	$486.91	$800.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $643.23 / $730.63 / $881.17	Professional		$643.23	$730.63	$881.17
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 $429.36 / $493.10 / $601.97	Professional	TC	$429.36	$493.10	$601.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $549.32 / $741.90 / $1,241.00	Professional		$549.32	$741.90	$1,241.00
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 $347.46 / $494.86 / $1,192.50	Professional	TC	$347.46	$494.86	$1,192.50
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 26 Low / Median / High Price $135.79 / $207.94 / $245.64	Professional	26	$135.79	$207.94	$245.64
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $344.08 / $477.04 / $793.13	Professional	TC	$344.08	$477.04	$793.13
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 $540.34 / $786.24 / $1,005.48	Professional		$540.34	$786.24	$1,005.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.71 / $198.24 / $316.64	Professional	26	$109.71	$198.24	$316.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $244.48 / $479.45 / $775.77	Professional	TC	$244.48	$479.45	$775.77
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 $600.29 / $786.02 / $994.48	Professional		$600.29	$786.02	$994.48
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 $406.38 / $533.29 / $730.17	Professional	TC	$406.38	$533.29	$730.17
United Facility/Professional Professional Modifier Low / Median / High Price $318.11 / $539.54 / $1,071.84	Professional		$318.11	$539.54	$1,071.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $128.63 / $335.65	Professional	26	$99.70	$128.63	$335.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.41 / $410.79 / $735.93	Professional	TC	$218.41	$410.79	$735.93