Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $520.97 / $723.89 / $2,440.63	Facility		$520.97	$723.89	$2,440.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $546.49 / $546.49 / $546.49	Facility	TC	$546.49	$546.49	$546.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.92 / $259.68 / $507.84	Professional		$182.92	$259.68	$507.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $81.11 / $394.25	Professional	26	$21.96	$81.11	$394.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.34 / $170.59 / $321.52	Professional	TC	$134.34	$170.59	$321.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $327.48 / $327.48 / $327.48	Facility		$327.48	$327.48	$327.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.33 / $281.47 / $436.10	Professional		$89.33	$281.47	$436.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.51 / $89.67 / $134.97	Professional	26	$39.51	$89.67	$134.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.51 / $191.80 / $321.52	Professional	TC	$50.51	$191.80	$321.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $274.23 / $568.02 / $809.64	Professional		$274.23	$568.02	$809.64
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.98 / $157.38 / $224.32	Professional	26	$75.98	$157.38	$224.32
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $198.25 / $410.64 / $585.30	Professional	TC	$198.25	$410.64	$585.30
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $192.57 / $295.70 / $648.95	Facility		$192.57	$295.70	$648.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $196.89 / $459.00 / $912.43	Professional		$196.89	$459.00	$912.43
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $121.80 / $142.04 / $251.44	Professional	26	$121.80	$142.04	$251.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.97 / $332.51 / $660.99	Professional	TC	$194.97	$332.51	$660.99
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $313.56 / $523.25 / $578.88	Facility		$313.56	$523.25	$578.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $118.70 / $157.37 / $161.84	Facility	26	$118.70	$157.37	$161.84
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $217.08 / $361.80 / $420.09	Facility	TC	$217.08	$361.80	$420.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.98 / $146.06 / $195.98	Professional	26	$109.98	$146.06	$195.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $203.04 / $271.35 / $507.87	Professional	TC	$203.04	$271.35	$507.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $260.23 / $650.50 / $838.08	Facility		$260.23	$650.50	$838.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $281.47 / $559.44 / $837.90	Professional		$281.47	$559.44	$837.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.48 / $89.67 / $138.59	Professional	26	$48.48	$89.67	$138.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.32 / $191.80 / $367.45	Professional	TC	$102.32	$191.80	$367.45
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,191.76 / $1,191.76 / $1,198.55	Facility		$1,191.76	$1,191.76	$1,198.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $517.10 / $567.16 / $922.75	Professional		$517.10	$567.16	$922.75
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $143.04 / $162.93 / $254.73	Professional	26	$143.04	$162.93	$254.73
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $374.06 / $404.25 / $669.64	Professional	TC	$374.06	$404.25	$669.64
United Facility/Professional Professional Modifier Low / Median / High Price $168.90 / $281.50 / $910.67	Professional		$168.90	$281.50	$910.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.97 / $86.62 / $251.90	Professional	26	$51.97	$86.62	$251.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.93 / $233.13 / $658.77	Professional	TC	$116.93	$233.13	$658.77