Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $263.64 / $948.17 / $1,395.42	Facility		$263.64	$948.17	$1,395.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.89 / $57.85 / $73.47	Facility	26	$41.89	$57.85	$73.47
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $217.16 / $347.99 / $1,222.20	Facility	TC	$217.16	$347.99	$1,222.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.68 / $233.70 / $871.00	Professional		$183.68	$233.70	$871.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.89 / $40.54 / $156.00	Professional	26	$31.89	$40.54	$156.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.80 / $186.80 / $427.06	Professional	TC	$151.80	$186.80	$427.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $170.75 / $636.79 / $835.09	Facility		$170.75	$636.79	$835.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.67 / $407.80 / $588.50	Professional		$241.67	$407.80	$588.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $67.90 / $100.83	Professional	26	$38.54	$67.90	$100.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.25 / $343.69 / $503.67	Professional	TC	$204.25	$343.69	$503.67
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $353.27 / $411.69 / $504.17	Professional		$353.27	$411.69	$504.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $59.97 / $71.14 / $81.89	Professional	26	$59.97	$71.14	$81.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $292.22 / $341.93 / $422.28	Professional	TC	$292.22	$341.93	$422.28
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $194.19 / $370.44 / $593.88	Facility		$194.19	$370.44	$593.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.14 / $361.34 / $574.38	Professional		$295.14	$361.34	$574.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $63.36 / $101.84	Professional	26	$51.23	$63.36	$101.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $243.90 / $322.25 / $484.85	Professional	TC	$243.90	$322.25	$484.85
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $274.89 / $364.14 / $433.20	Facility		$274.89	$364.14	$433.20
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $48.51 / $62.93 / $66.33	Facility	26	$48.51	$62.93	$66.33
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $243.27 / $301.20 / $322.42	Facility	TC	$243.27	$301.20	$322.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $38.99 / $57.00 / $73.50	Professional	26	$38.99	$57.00	$73.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $188.14 / $293.76 / $383.40	Professional	TC	$188.14	$293.76	$383.40
Providence Facility/Professional Facility Modifier Low / Median / High Price $194.19 / $422.48 / $563.20	Facility		$194.19	$422.48	$563.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $341.75 / $426.08 / $549.02	Professional		$341.75	$426.08	$549.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.85 / $70.91 / $93.80	Professional	26	$44.85	$70.91	$93.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $214.62 / $353.07 / $456.29	Professional	TC	$214.62	$353.07	$456.29
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 $342.55 / $442.12 / $535.34	Professional		$342.55	$442.12	$535.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.89 / $75.70 / $92.86	Professional	26	$60.89	$75.70	$92.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $277.55 / $365.68 / $442.48	Professional	TC	$277.55	$365.68	$442.48
United Facility/Professional Professional Modifier Low / Median / High Price $228.95 / $385.69 / $569.50	Professional		$228.95	$385.69	$569.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.25 / $64.68 / $101.14	Professional	26	$42.25	$64.68	$101.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.48 / $320.91 / $496.83	Professional	TC	$185.48	$320.91	$496.83