Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.78 / $254.32 / $563.90	Facility	26	$105.78	$254.32	$563.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.85 / $372.31 / $1,723.34	Professional		$242.85	$372.31	$1,723.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.29 / $127.38 / $574.00	Professional	26	$90.29	$127.38	$574.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.66 / $274.20 / $491.96	Professional	TC	$154.66	$274.20	$491.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.23 / $731.96 / $1,094.21	Professional		$354.23	$731.96	$1,094.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.76 / $201.17 / $325.43	Professional	26	$108.76	$201.17	$325.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $240.31 / $532.87 / $766.88	Professional	TC	$240.31	$532.87	$766.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $648.63 / $728.61 / $887.77	Professional		$648.63	$728.61	$887.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $215.50 / $248.07 / $289.85	Professional	26	$215.50	$248.07	$289.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $426.51 / $484.15 / $597.91	Professional	TC	$426.51	$484.15	$597.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $525.17 / $694.11 / $1,009.50	Professional		$525.17	$694.11	$1,009.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $179.87 / $237.64 / $341.58	Professional	26	$179.87	$237.64	$341.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $345.31 / $476.07 / $686.44	Professional	TC	$345.31	$476.07	$686.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $165.13 / $222.12 / $226.46	Facility	26	$165.13	$222.12	$226.46
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $140.29 / $140.29 / $140.29	Professional		$140.29	$140.29	$140.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $152.97 / $197.20 / $257.04	Professional	26	$152.97	$197.20	$257.04
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $356.32 / $484.08 / $627.52	Professional	TC	$356.32	$484.08	$627.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.94 / $128.94 / $128.94	Facility	26	$128.94	$128.94	$128.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $541.90 / $801.99 / $1,022.18	Professional		$541.90	$801.99	$1,022.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $113.92 / $201.17 / $328.45	Professional	26	$113.92	$201.17	$328.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $240.31 / $532.87 / $776.68	Professional	TC	$240.31	$532.87	$776.68
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 $594.30 / $803.44 / $940.87	Professional		$594.30	$803.44	$940.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $201.10 / $237.72 / $318.36	Professional	26	$201.10	$237.72	$318.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $393.21 / $538.61 / $641.63	Professional	TC	$393.21	$538.61	$641.63
United Facility/Professional Professional Modifier Low / Median / High Price $310.75 / $526.76 / $1,056.45	Professional		$310.75	$526.76	$1,056.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.63 / $151.24 / $346.26	Professional	26	$102.63	$151.24	$346.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $207.98 / $385.24 / $700.79	Professional	TC	$207.98	$385.24	$700.79