Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $413.82 / $1,023.70 / $1,232.02	Facility		$413.82	$1,023.70	$1,232.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.64 / $62.60 / $82.71	Facility	26	$47.64	$62.60	$82.71
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $322.01 / $454.90 / $1,261.00	Facility	TC	$322.01	$454.90	$1,261.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.49 / $268.94 / $884.00	Professional		$178.49	$268.94	$884.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $37.77 / $151.13	Professional	26	$26.96	$37.77	$151.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $210.72 / $509.36	Professional	TC	$162.34	$210.72	$509.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $223.23 / $636.79 / $835.09	Facility		$223.23	$636.79	$835.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.95 / $531.66 / $766.51	Professional		$301.95	$531.66	$766.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $75.83 / $115.54	Professional	26	$40.71	$75.83	$115.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $265.77 / $456.99 / $653.00	Professional	TC	$265.77	$456.99	$653.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $452.26 / $527.04 / $646.29	Professional		$452.26	$527.04	$646.29
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $68.66 / $81.45 / $93.75	Professional	26	$68.66	$81.45	$93.75
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $382.37 / $447.40 / $552.54	Professional	TC	$382.37	$447.40	$552.54
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $235.87 / $467.74 / $723.35	Facility		$235.87	$467.74	$723.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $377.87 / $467.18 / $731.97	Professional		$377.87	$467.18	$731.97
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $71.79 / $116.70	Professional	26	$54.27	$71.79	$116.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $319.16 / $423.45 / $634.45	Professional	TC	$319.16	$423.45	$634.45
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $354.84 / $466.17 / $531.24	Facility		$354.84	$466.17	$531.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.71 / $72.04 / $75.04	Facility	26	$53.71	$72.04	$75.04
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $300.87 / $394.13 / $425.45	Facility	TC	$300.87	$394.13	$425.45
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.39 / $57.11 / $78.95	Professional	26	$42.39	$57.11	$78.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $232.76 / $381.15 / $494.72	Professional	TC	$232.76	$381.15	$494.72
Providence Facility/Professional Facility Modifier Low / Median / High Price $245.22 / $529.89 / $723.35	Facility		$245.22	$529.89	$723.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $442.88 / $550.03 / $705.60	Professional		$442.88	$550.03	$705.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.86 / $78.09 / $107.16	Professional	26	$44.86	$78.09	$107.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $292.92 / $469.17 / $613.95	Professional	TC	$292.92	$469.17	$613.95
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $637.02 / $797.96 / $962.78	Facility		$637.02	$797.96	$962.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	26	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $782.93 / $782.93 / $782.93	Facility	TC	$782.93	$782.93	$782.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $449.80 / $568.22 / $687.60	Professional		$449.80	$568.22	$687.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $69.58 / $86.64 / $104.23	Professional	26	$69.58	$86.64	$104.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $376.35 / $480.74 / $581.25	Professional	TC	$376.35	$480.74	$581.25
United Facility/Professional Professional Modifier Low / Median / High Price $279.63 / $501.90 / $745.93	Professional		$279.63	$501.90	$745.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $75.48 / $114.73	Professional	26	$40.47	$75.48	$114.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.64 / $419.35 / $627.66	Professional	TC	$229.64	$419.35	$627.66