Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $225.19 / $519.65	Facility	26	$127.92	$225.19	$519.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.53 / $522.50 / $2,270.38	Professional		$357.53	$522.50	$2,270.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $161.00 / $547.00	Professional	26	$104.00	$161.00	$547.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.32 / $368.50 / $931.29	Professional	TC	$251.32	$368.50	$931.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $374.42 / $756.85 / $1,225.98	Professional		$374.42	$756.85	$1,225.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.94 / $187.21 / $302.88	Professional	26	$102.94	$187.21	$302.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $269.45 / $570.45 / $935.62	Professional	TC	$269.45	$570.45	$935.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $677.74 / $774.58 / $930.37	Professional		$677.74	$774.58	$930.37
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $198.64 / $228.66 / $267.26	Professional	26	$198.64	$228.66	$267.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $472.97 / $547.16 / $663.11	Professional	TC	$472.97	$547.16	$663.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $563.44 / $781.42 / $1,271.68	Professional		$563.44	$781.42	$1,271.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $165.99 / $211.05 / $315.14	Professional	26	$165.99	$211.05	$315.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $382.67 / $545.01 / $1,388.12	Professional	TC	$382.67	$545.01	$1,388.12
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $158.27 / $204.76 / $216.41	Facility	26	$158.27	$204.76	$216.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $241.83 / $241.83 / $241.83	Professional		$241.83	$241.83	$241.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $125.20 / $188.10 / $234.85	Professional	26	$125.20	$188.10	$234.85
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $325.10 / $566.41 / $1,082.28	Professional	TC	$325.10	$566.41	$1,082.28
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $569.76 / $859.21 / $1,092.83	Professional		$569.76	$859.21	$1,092.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $106.59 / $191.20 / $302.88	Professional	26	$106.59	$191.20	$302.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $274.98 / $558.54 / $882.26	Professional	TC	$274.98	$558.54	$882.26
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 $635.01 / $855.78 / $1,062.72	Professional		$635.01	$855.78	$1,062.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $185.54 / $221.45 / $293.73	Professional	26	$185.54	$221.45	$293.73
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $449.47 / $603.07 / $859.49	Professional	TC	$449.47	$603.07	$859.49
United Facility/Professional Professional Modifier Low / Median / High Price $337.75 / $738.05 / $1,177.70	Professional		$337.75	$738.05	$1,177.70
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 $242.65 / $449.45 / $830.97	Professional	TC	$242.65	$449.45	$830.97