Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $201.94 / $471.37	Facility	26	$127.92	$201.94	$471.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $400.00 / $522.50 / $2,537.96	Professional		$400.00	$522.50	$2,537.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $145.65 / $509.00	Professional	26	$104.00	$145.65	$509.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $305.00 / $410.53 / $953.39	Professional	TC	$305.00	$410.53	$953.39
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 $428.55 / $838.93 / $1,369.42	Professional		$428.55	$838.93	$1,369.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.95 / $182.51 / $296.45	Professional	26	$100.95	$182.51	$296.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $325.62 / $652.53 / $1,055.61	Professional	TC	$325.62	$652.53	$1,055.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $769.52 / $889.52 / $1,059.51	Professional		$769.52	$889.52	$1,059.51
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 $568.76 / $666.64 / $797.42	Professional	TC	$568.76	$666.64	$797.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $641.72 / $816.48 / $1,238.13	Professional		$641.72	$816.48	$1,238.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.79 / $204.21 / $309.06	Professional	26	$162.79	$204.21	$309.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $460.07 / $655.25 / $1,384.85	Professional	TC	$460.07	$655.25	$1,384.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $150.43 / $200.75 / $205.69	Facility	26	$150.43	$200.75	$205.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $122.61 / $176.90 / $215.84	Professional	26	$122.61	$176.90	$215.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $426.92 / $626.58 / $861.30	Professional	TC	$426.92	$626.58	$861.30
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 $651.38 / $959.40 / $1,204.28	Professional		$651.38	$959.40	$1,204.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $104.51 / $183.85 / $296.98	Professional	26	$104.51	$183.85	$296.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $325.62 / $645.00 / $1,006.18	Professional	TC	$325.62	$645.00	$1,006.18
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 $725.98 / $947.25 / $1,163.94	Professional		$725.98	$947.25	$1,163.94
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 $544.04 / $713.93 / $926.39	Professional	TC	$544.04	$713.93	$926.39
United Facility/Professional Professional Modifier Low / Median / High Price $389.59 / $732.92 / $1,300.48	Professional		$389.59	$732.92	$1,300.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.25 / $120.64 / $313.73	Professional	26	$93.25	$120.64	$313.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $296.33 / $466.02 / $998.47	Professional	TC	$296.33	$466.02	$998.47