Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $439.64 / $950.00 / $2,425.00	Facility		$439.64	$950.00	$2,425.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.68 / $638.14 / $671.89	Facility	26	$94.68	$638.14	$671.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.66 / $274.27 / $881.00	Professional		$189.66	$274.27	$881.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.20 / $78.51 / $267.00	Professional	26	$64.20	$78.51	$267.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $143.05 / $183.20 / $384.15	Professional	TC	$143.05	$183.20	$384.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $261.23 / $437.98 / $611.15	Professional		$261.23	$437.98	$611.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.38 / $142.07 / $214.00	Professional	26	$83.38	$142.07	$214.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $179.91 / $289.47 / $416.84	Professional	TC	$179.91	$289.47	$416.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $372.14 / $433.68 / $524.70	Professional		$372.14	$433.68	$524.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $127.92 / $151.38 / $174.68	Professional	26	$127.92	$151.38	$174.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $242.22 / $283.42 / $350.03	Professional	TC	$242.22	$283.42	$350.03
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $202.55 / $392.22 / $964.25	Facility		$202.55	$392.22	$964.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $284.07 / $360.83 / $595.74	Professional		$284.07	$360.83	$595.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.81 / $140.22 / $214.32	Professional	26	$107.81	$140.22	$214.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.27 / $268.64 / $402.10	Professional	TC	$202.27	$268.64	$402.10
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $315.07 / $383.58 / $432.15	Facility		$315.07	$383.58	$432.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $94.43 / $130.69 / $138.04	Facility	26	$94.43	$130.69	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $73.16 / $115.20 / $136.76	Professional	26	$73.16	$115.20	$136.76
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $158.69 / $253.26 / $320.76	Professional	TC	$158.69	$253.26	$320.76
Providence Facility/Professional Facility Modifier Low / Median / High Price $202.55 / $431.99 / $566.10	Facility		$202.55	$431.99	$566.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $350.91 / $448.00 / $574.24	Professional		$350.91	$448.00	$574.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $90.87 / $145.11 / $198.64	Professional	26	$90.87	$145.11	$198.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $181.63 / $289.47 / $380.57	Professional	TC	$181.63	$289.47	$380.57
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,357.38 / $1,801.21 / $2,065.73	Facility		$1,357.38	$1,801.21	$2,065.73
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,640.24 / $1,640.24 / $1,640.24	Facility	26	$1,640.24	$1,640.24	$1,640.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $370.65 / $459.71 / $558.45	Professional		$370.65	$459.71	$558.45
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.00 / $157.66 / $191.30	Professional	26	$117.00	$157.66	$191.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $243.51 / $302.05 / $364.79	Professional	TC	$243.51	$302.05	$364.79
United Facility/Professional Professional Modifier Low / Median / High Price $229.27 / $421.93 / $607.10	Professional		$229.27	$421.93	$607.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.64 / $135.27 / $213.00	Professional	26	$79.64	$135.27	$213.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.79 / $290.42 / $405.80	Professional	TC	$164.79	$290.42	$405.80