Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $221.21 / $252.15 / $558.90	Facility	26	$221.21	$252.15	$558.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $274.47 / $461.44 / $941.00	Professional		$274.47	$461.44	$941.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $122.79 / $525.66	Professional	26	$86.00	$122.79	$525.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.78 / $345.83 / $570.00	Professional	TC	$154.78	$345.83	$570.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $437.07 / $768.58 / $1,242.99	Professional		$437.07	$768.58	$1,242.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.43 / $199.39 / $326.48	Professional	26	$110.43	$199.39	$326.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $326.33 / $567.74 / $916.51	Professional	TC	$326.33	$567.74	$916.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $824.78 / $922.62 / $1,134.75	Professional		$824.78	$922.62	$1,134.75
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $213.35 / $245.59 / $286.70	Professional	26	$213.35	$245.59	$286.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $604.87 / $686.65 / $848.02	Professional	TC	$604.87	$686.65	$848.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $667.67 / $776.93 / $1,294.14	Professional		$667.67	$776.93	$1,294.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $178.27 / $229.81 / $338.52	Professional	26	$178.27	$229.81	$338.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $489.42 / $697.06 / $972.91	Professional	TC	$489.42	$697.06	$972.91
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $166.60 / $219.91 / $227.80	Facility	26	$166.60	$219.91	$227.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $144.05 / $191.52 / $245.25	Professional	26	$144.05	$191.52	$245.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $343.35 / $506.41 / $731.20	Professional	TC	$343.35	$506.41	$731.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $128.28 / $128.28 / $128.28	Facility	26	$128.28	$128.28	$128.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $631.89 / $924.26 / $1,234.05	Professional		$631.89	$924.26	$1,234.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $114.89 / $201.48 / $326.48	Professional	26	$114.89	$201.48	$326.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $341.50 / $567.10 / $916.51	Professional	TC	$341.50	$567.10	$916.51
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 $761.89 / $900.97 / $1,206.17	Professional		$761.89	$900.97	$1,206.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $199.30 / $238.43 / $315.52	Professional	26	$199.30	$238.43	$315.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $562.00 / $691.13 / $890.65	Professional	TC	$562.00	$691.13	$890.65
United Facility/Professional Professional Modifier Low / Median / High Price $358.69 / $601.61 / $1,288.97	Professional		$358.69	$601.61	$1,288.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.77 / $126.38 / $344.97	Professional	26	$102.77	$126.38	$344.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.70 / $475.28 / $1,000.07	Professional	TC	$263.70	$475.28	$1,000.07