Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $200.99 / $438.63	Facility	26	$105.78	$200.99	$438.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $318.61 / $454.07 / $1,691.00	Professional		$318.61	$454.07	$1,691.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $108.88 / $351.13	Professional	26	$84.53	$108.88	$351.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $252.59 / $354.71 / $1,036.38	Professional	TC	$252.59	$354.71	$1,036.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $376.97 / $628.21 / $1,027.83	Professional		$376.97	$628.21	$1,027.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.78 / $170.57 / $276.33	Professional	26	$93.78	$170.57	$276.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $275.47 / $464.00 / $754.25	Professional	TC	$275.47	$464.00	$754.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $678.67 / $780.51 / $933.43	Professional		$678.67	$780.51	$933.43
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $180.97 / $208.33 / $243.48	Professional	26	$180.97	$208.33	$243.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $492.13 / $572.27 / $689.98	Professional	TC	$492.13	$572.27	$689.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $549.20 / $667.50 / $1,083.72	Professional		$549.20	$667.50	$1,083.72
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $151.04 / $200.08 / $287.70	Professional	26	$151.04	$200.08	$287.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $398.15 / $532.44 / $796.02	Professional	TC	$398.15	$532.44	$796.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $140.63 / $186.54 / $192.29	Facility	26	$140.63	$186.54	$192.29
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 $114.97 / $163.02 / $199.19	Professional	26	$114.97	$163.02	$199.19
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $312.76 / $459.02 / $557.46	Professional	TC	$312.76	$459.02	$557.46
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $108.46 / $108.46 / $108.46	Facility	26	$108.46	$108.46	$108.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $533.44 / $773.46 / $1,007.78	Professional		$533.44	$773.46	$1,007.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $95.77 / $170.57 / $276.33	Professional	26	$95.77	$170.57	$276.33
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $417.40 / $417.40 / $417.40	Professional	52	$417.40	$417.40	$417.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $277.10 / $465.01 / $754.25	Professional	TC	$277.10	$465.01	$754.25
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 $638.00 / $789.27 / $1,010.04	Professional		$638.00	$789.27	$1,010.04
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $169.38 / $201.64 / $268.14	Professional	26	$169.38	$201.64	$268.14
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $468.63 / $573.34 / $741.89	Professional	TC	$468.63	$573.34	$741.89
United Facility/Professional Professional Modifier Low / Median / High Price $304.44 / $443.48 / $1,068.13	Professional		$304.44	$443.48	$1,068.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.12 / $126.35 / $293.19	Professional	26	$87.12	$126.35	$293.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.38 / $472.38 / $776.25	Professional	TC	$230.38	$472.38	$776.25