Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $184.19 / $210.17 / $424.17	Facility	26	$184.19	$210.17	$424.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $368.50 / $550.00 / $2,187.03	Professional		$368.50	$550.00	$2,187.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.96 / $129.13 / $215.47	Professional	26	$84.96	$129.13	$215.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $264.87 / $359.04 / $722.42	Professional	TC	$264.87	$359.04	$722.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $372.99 / $710.40 / $1,104.18	Professional		$372.99	$710.40	$1,104.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.98 / $153.16 / $247.81	Professional	26	$83.98	$153.16	$247.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.30 / $559.63 / $855.35	Professional	TC	$287.30	$559.63	$855.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $675.62 / $762.56 / $930.81	Professional		$675.62	$762.56	$930.81
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $162.21 / $186.72 / $218.03	Professional	26	$162.21	$186.72	$218.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $508.43 / $577.15 / $712.78	Professional	TC	$508.43	$577.15	$712.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $580.21 / $722.78 / $1,066.44	Professional		$580.21	$722.78	$1,066.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.56 / $170.18 / $258.20	Professional	26	$135.56	$170.18	$258.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $411.49 / $586.07 / $818.00	Professional	TC	$411.49	$586.07	$818.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $125.93 / $167.21 / $172.19	Facility	26	$125.93	$167.21	$172.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.31 / $151.63 / $192.00	Professional	26	$103.31	$151.63	$192.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $374.26 / $566.79 / $794.02	Professional	TC	$374.26	$566.79	$794.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $97.37 / $97.37 / $97.37	Facility	26	$97.37	$97.37	$97.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $568.86 / $822.90 / $1,039.64	Professional		$568.86	$822.90	$1,039.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.21 / $154.31 / $247.81	Professional	26	$87.21	$154.31	$247.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $287.30 / $559.63 / $869.04	Professional	TC	$287.30	$559.63	$869.04
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $627.83 / $817.84 / $1,013.31	Professional		$627.83	$817.84	$1,013.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $152.02 / $180.41 / $240.67	Professional	26	$152.02	$180.41	$240.67
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $475.81 / $624.39 / $786.58	Professional	TC	$475.81	$624.39	$786.58
United Facility/Professional Professional Modifier Low / Median / High Price $333.75 / $510.45 / $1,116.04	Professional		$333.75	$510.45	$1,116.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.23 / $114.61 / $261.13	Professional	26	$78.23	$114.61	$261.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.52 / $363.36 / $852.97	Professional	TC	$255.52	$363.36	$852.97