Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $246.26 / $280.58 / $566.87	Facility	26	$246.26	$280.58	$566.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.39 / $328.98 / $703.93	Professional		$191.39	$328.98	$703.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $114.84 / $280.58	Professional	26	$86.00	$114.84	$280.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.62 / $206.71 / $295.08	Professional	TC	$101.62	$206.71	$295.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.99 / $846.75 / $1,254.79	Professional		$416.99	$846.75	$1,254.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.37 / $204.59 / $330.42	Professional	26	$106.37	$204.59	$330.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $299.79 / $638.50 / $924.38	Professional	TC	$299.79	$638.50	$924.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $824.34 / $957.78 / $1,134.15	Professional		$824.34	$957.78	$1,134.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $217.19 / $250.01 / $292.26	Professional	26	$217.19	$250.01	$292.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $600.48 / $709.02 / $841.89	Professional	TC	$600.48	$709.02	$841.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $687.36 / $825.60 / $1,326.20	Professional		$687.36	$825.60	$1,326.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $181.47 / $239.76 / $344.64	Professional	26	$181.47	$239.76	$344.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $485.68 / $691.72 / $982.05	Professional	TC	$485.68	$691.72	$982.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $167.58 / $223.87 / $230.48	Facility	26	$167.58	$223.87	$230.48
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $78.25 / $78.25 / $78.25	Professional		$78.25	$78.25	$78.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $137.60 / $216.32 / $244.95	Professional	26	$137.60	$216.32	$244.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $413.60 / $617.40 / $739.50	Professional	TC	$413.60	$617.40	$739.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $129.66 / $129.66 / $129.66	Facility	26	$129.66	$129.66	$129.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $645.04 / $975.26 / $1,254.79	Professional		$645.04	$975.26	$1,254.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $114.52 / $204.59 / $330.42	Professional	26	$114.52	$204.59	$330.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $324.27 / $643.90 / $963.45	Professional	TC	$324.27	$643.90	$963.45
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $781.04 / $972.34 / $1,236.49	Professional		$781.04	$972.34	$1,236.49
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $202.89 / $241.97 / $321.20	Professional	26	$202.89	$241.97	$321.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $578.15 / $753.69 / $915.28	Professional	TC	$578.15	$753.69	$915.28
United Facility/Professional Professional Modifier Low / Median / High Price $412.28 / $778.33 / $1,443.99	Professional		$412.28	$778.33	$1,443.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.30 / $127.89 / $348.15	Professional	26	$104.30	$127.89	$348.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $307.98 / $479.55 / $1,021.07	Professional	TC	$307.98	$479.55	$1,021.07