Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $229.74 / $509.45	Facility	26	$127.92	$229.74	$509.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $364.32 / $540.00 / $1,459.50	Professional		$364.32	$540.00	$1,459.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.25 / $145.65 / $537.54	Professional	26	$103.25	$145.65	$537.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $305.00 / $444.85 / $1,034.02	Professional	TC	$305.00	$444.85	$1,034.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $456.08 / $893.02 / $1,409.30	Professional		$456.08	$893.02	$1,409.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.95 / $183.13 / $296.98	Professional	26	$100.95	$183.13	$296.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $353.16 / $701.66 / $1,142.04	Professional	TC	$353.16	$701.66	$1,142.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $819.50 / $944.23 / $1,129.56	Professional		$819.50	$944.23	$1,129.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $194.76 / $224.19 / $262.08	Professional	26	$194.76	$224.19	$262.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $618.75 / $720.62 / $867.46	Professional	TC	$618.75	$720.62	$867.46
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $663.42 / $858.50 / $1,318.79	Professional		$663.42	$858.50	$1,318.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.79 / $201.00 / $309.06	Professional	26	$162.79	$201.00	$309.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $500.63 / $713.01 / $1,283.05	Professional	TC	$500.63	$713.01	$1,283.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $148.74 / $200.75 / $205.69	Facility	26	$148.74	$200.75	$205.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $289.11 / $487.84	Professional		$268.35	$289.11	$487.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.61 / $179.95 / $213.92	Professional	26	$122.61	$179.95	$213.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $458.28 / $664.51 / $1,038.96	Professional	TC	$458.28	$664.51	$1,038.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.52 / $116.52 / $116.52	Facility	26	$116.52	$116.52	$116.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $692.19 / $1,016.39 / $1,278.33	Professional		$692.19	$1,016.39	$1,278.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $104.86 / $183.85 / $296.98	Professional	26	$104.86	$183.85	$296.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $353.16 / $691.25 / $1,078.91	Professional	TC	$353.16	$691.25	$1,078.91
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 $771.47 / $1,005.02 / $1,221.33	Professional		$771.47	$1,005.02	$1,221.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $181.94 / $215.79 / $288.04	Professional	26	$181.94	$215.79	$288.04
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $589.52 / $773.62 / $1,001.65	Professional	TC	$589.52	$773.62	$1,001.65
United Facility/Professional Professional Modifier Low / Median / High Price $413.52 / $632.44 / $1,380.36	Professional		$413.52	$632.44	$1,380.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $135.96 / $327.83	Professional	26	$93.26	$135.96	$327.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $320.26 / $542.88 / $1,077.42	Professional	TC	$320.26	$542.88	$1,077.42