Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $207.86 / $517.13	Facility	26	$105.78	$207.86	$517.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $344.32 / $541.83 / $1,078.73	Professional		$344.32	$541.83	$1,078.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $132.38 / $442.63	Professional	26	$86.00	$132.38	$442.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $254.30 / $447.91 / $795.26	Professional	TC	$254.30	$447.91	$795.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $418.96 / $693.13 / $1,151.54	Professional		$418.96	$693.13	$1,151.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.45 / $185.34 / $301.32	Professional	26	$102.45	$185.34	$301.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $305.97 / $520.38 / $849.64	Professional	TC	$305.97	$520.38	$849.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $762.49 / $862.80 / $1,049.18	Professional		$762.49	$862.80	$1,049.18
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $197.77 / $227.66 / $265.99	Professional	26	$197.77	$227.66	$265.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $558.64 / $636.41 / $783.19	Professional	TC	$558.64	$636.41	$783.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $624.96 / $759.90 / $1,205.70	Professional		$624.96	$759.90	$1,205.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.45 / $218.59 / $314.13	Professional	26	$165.45	$218.59	$314.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $452.05 / $628.61 / $891.57	Professional	TC	$452.05	$628.61	$891.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $152.88 / $203.87 / $209.71	Facility	26	$152.88	$203.87	$209.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $298.17 / $506.12	Professional		$268.35	$298.17	$506.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $135.08 / $184.08 / $220.10	Professional	26	$135.08	$184.08	$220.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $368.17 / $525.95 / $707.02	Professional	TC	$368.17	$525.95	$707.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.52 / $118.52 / $118.52	Facility	26	$118.52	$118.52	$118.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $597.54 / $884.41 / $1,135.86	Professional		$597.54	$884.41	$1,135.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $104.47 / $185.34 / $301.89	Professional	26	$104.47	$185.34	$301.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $306.61 / $520.38 / $891.75	Professional	TC	$306.61	$520.38	$891.75
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $709.82 / $908.90 / $1,123.46	Professional		$709.82	$908.90	$1,123.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $184.94 / $219.33 / $292.77	Professional	26	$184.94	$219.33	$292.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $524.88 / $670.90 / $830.96	Professional	TC	$524.88	$670.90	$830.96
United Facility/Professional Professional Modifier Low / Median / High Price $349.71 / $561.84 / $1,229.36	Professional		$349.71	$561.84	$1,229.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.10 / $131.96 / $319.93	Professional	26	$95.10	$131.96	$319.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $252.61 / $458.51 / $895.06	Professional	TC	$252.61	$458.51	$895.06