Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.75 / $131.75 / $145.68	Facility	26	$131.75	$131.75	$145.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $360.43 / $524.35 / $1,022.27	Professional		$360.43	$524.35	$1,022.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.55 / $71.28 / $145.68	Professional	26	$56.55	$71.28	$145.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $179.24 / $252.00 / $557.32	Professional	52	$179.24	$252.00	$557.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $300.74 / $452.26 / $866.41	Professional	TC	$300.74	$452.26	$866.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $564.01 / $919.29 / $1,209.56	Professional		$564.01	$919.29	$1,209.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.88 / $124.66 / $169.59	Professional	26	$83.88	$124.66	$169.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $469.90 / $787.06 / $1,038.45	Professional	TC	$469.90	$787.06	$1,038.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $748.42 / $975.84 / $1,135.22	Professional		$748.42	$975.84	$1,135.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $101.88 / $132.50 / $149.18	Professional	26	$101.88	$132.50	$149.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $646.54 / $839.93 / $986.03	Professional	TC	$646.54	$839.93	$986.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $662.87 / $812.58 / $1,173.42	Professional		$662.87	$812.58	$1,173.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.33 / $125.91 / $183.55	Professional	26	$92.33	$125.91	$183.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $518.66 / $727.26 / $1,134.16	Professional	TC	$518.66	$727.26	$1,134.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $86.73 / $114.57 / $122.83	Facility	26	$86.73	$114.57	$122.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.80 / $102.71 / $130.97	Professional	26	$70.80	$102.71	$130.97
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $451.20 / $657.78 / $812.70	Professional	TC	$451.20	$657.78	$812.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $544.32 / $871.20 / $1,098.02	Professional		$544.32	$871.20	$1,098.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.28 / $129.44 / $169.59	Professional	26	$79.28	$129.44	$169.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $469.90 / $787.66 / $1,040.10	Professional	TC	$469.90	$787.66	$1,040.10
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,497.68 / $1,497.68 / $1,497.68	Facility	26	$1,497.68	$1,497.68	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $623.70 / $814.28 / $1,094.35	Professional		$623.70	$814.28	$1,094.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.42 / $116.87 / $163.92	Professional	26	$93.42	$116.87	$163.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $530.28 / $699.36 / $930.45	Professional	TC	$530.28	$699.36	$930.45
United Facility/Professional Professional Modifier Low / Median / High Price $587.90 / $873.83 / $1,212.03	Professional		$587.90	$873.83	$1,212.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.00 / $132.04 / $184.04	Professional	26	$91.00	$132.04	$184.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $525.95 / $806.95 / $1,035.05	Professional	TC	$525.95	$806.95	$1,035.05