Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $252.96 / $511.29	Facility	26	$127.92	$252.96	$511.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $554.47 / $2,167.50	Professional		$400.00	$554.47	$2,167.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $142.59 / $473.51	Professional	26	$104.00	$142.59	$473.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $305.00 / $420.41 / $1,461.00	Professional	TC	$305.00	$420.41	$1,461.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $430.38 / $840.20 / $1,371.48	Professional		$430.38	$840.20	$1,371.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.95 / $183.13 / $297.43	Professional	26	$100.95	$183.13	$297.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $327.08 / $653.16 / $1,056.65	Professional	TC	$327.08	$653.16	$1,056.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $771.50 / $892.40 / $1,062.29	Professional		$771.50	$892.40	$1,062.29
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 $570.75 / $668.81 / $800.19	Professional	TC	$570.75	$668.81	$800.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $643.37 / $808.01 / $1,241.32	Professional		$643.37	$808.01	$1,241.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.79 / $204.87 / $310.08	Professional	26	$162.79	$204.87	$310.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $461.67 / $657.53 / $1,384.85	Professional	TC	$461.67	$657.53	$1,384.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $150.43 / $200.75 / $206.36	Facility	26	$150.43	$200.75	$206.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $298.17 / $298.17	Professional		$268.35	$298.17	$298.17
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $123.82 / $182.71 / $218.68	Professional	26	$123.82	$182.71	$218.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $425.32 / $614.46 / $917.00	Professional	TC	$425.32	$614.46	$917.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $116.87 / $116.87 / $116.87	Facility	26	$116.87	$116.87	$116.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $653.53 / $962.52 / $1,205.03	Professional		$653.53	$962.52	$1,205.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $104.86 / $183.85 / $297.95	Professional	26	$104.86	$183.85	$297.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $327.08 / $647.25 / $1,010.72	Professional	TC	$327.08	$647.25	$1,010.72
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 $728.37 / $949.66 / $1,168.83	Professional		$728.37	$949.66	$1,168.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $182.54 / $216.50 / $288.99	Professional	26	$182.54	$216.50	$288.99
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $545.83 / $716.28 / $928.31	Professional	TC	$545.83	$716.28	$928.31
United Facility/Professional Professional Modifier Low / Median / High Price $390.20 / $569.20 / $1,302.53	Professional		$390.20	$569.20	$1,302.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.25 / $121.03 / $313.26	Professional	26	$93.25	$121.03	$313.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.95 / $397.95 / $991.24	Professional	TC	$296.95	$397.95	$991.24