Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $724.44 / $2,454.71	Facility		$524.81	$724.44	$2,454.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	26	$83.18	$83.18	$83.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $776.25 / $776.25 / $977.24	Facility	TC	$776.25	$776.25	$977.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $275.42 / $812.83	Professional		$181.97	$275.42	$812.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $173.78 / $676.08	Professional	26	$72.44	$173.78	$676.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $190.55 / $389.05	Professional	TC	$144.54	$190.55	$389.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $331.13 / $331.13 / $331.13	Facility		$331.13	$331.13	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $257.04 / $436.52	Professional		$123.03	$257.04	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $67.61 / $134.90	Professional	26	$39.81	$67.61	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $190.55 / $323.59	Professional	TC	$58.88	$190.55	$323.59
HealthNet Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	26	$147.91	$147.91	$147.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $549.54 / $794.33	Professional		$275.42	$549.54	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $151.36 / $218.78	Professional	26	$75.86	$151.36	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $398.11 / $575.44	Professional	TC	$199.53	$398.11	$575.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $457.09 / $1,288.25	Facility		$234.42	$457.09	$1,288.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	26	$83.18	$83.18	$83.18
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $776.25 / $776.25 / $977.24	Facility	TC	$776.25	$776.25	$977.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $457.09 / $912.01	Professional		$263.03	$457.09	$912.01
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $151.36 / $346.74	Professional	26	$81.28	$151.36	$346.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $323.59 / $660.69	Professional	TC	$144.54	$323.59	$660.69
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $524.81 / $575.44	Facility		$363.08	$524.81	$575.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $158.49 / $162.18	Facility	26	$128.82	$158.49	$162.18
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $234.42 / $363.08 / $416.87	Facility	TC	$234.42	$363.08	$416.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $134.90 / $173.78	Professional	26	$95.50	$134.90	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $275.42 / $416.87	Professional	TC	$204.17	$275.42	$416.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $354.81 / $676.08	Facility		$234.42	$354.81	$676.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $537.03 / $870.96	Professional		$218.78	$537.03	$870.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $83.18 / $234.42	Professional	26	$48.98	$83.18	$234.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $223.87 / $616.60	Professional	TC	$102.33	$223.87	$616.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,380.38	Facility		$1,348.96	$1,348.96	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $562.34 / $912.01	Professional		$346.74	$562.34	$912.01
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $162.18 / $251.19	Professional	26	$95.50	$162.18	$251.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $398.11 / $660.69	Professional	TC	$251.19	$398.11	$660.69
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $912.01	Professional		$169.82	$281.84	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $87.10 / $251.19	Professional	26	$51.29	$87.10	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $194.98 / $660.69	Professional	TC	$117.49	$194.98	$660.69