Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $191.92 / $263.08 / $310.19	Facility	26	$191.92	$263.08	$310.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $656.76 / $786.19 / $2,002.40	Professional		$656.76	$786.19	$2,002.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.82 / $156.04 / $618.00	Professional	26	$117.82	$156.04	$618.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $284.48 / $381.18 / $803.63	Professional	52	$284.48	$381.18	$803.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $492.83 / $650.99 / $1,402.71	Professional	TC	$492.83	$650.99	$1,402.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $133.97 / $133.97 / $133.97	Facility	26	$133.97	$133.97	$133.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $848.10 / $1,375.33 / $1,745.32	Professional		$848.10	$1,375.33	$1,745.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.53 / $249.21 / $341.23	Professional	26	$165.53	$249.21	$341.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $669.23 / $1,113.86 / $1,440.30	Professional	TC	$669.23	$1,113.86	$1,440.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,132.44 / $1,476.55 / $1,715.12	Professional		$1,132.44	$1,476.55	$1,715.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $204.49 / $266.22 / $299.74	Professional	26	$204.49	$266.22	$299.74
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $927.95 / $1,205.61 / $1,415.38	Professional	TC	$927.95	$1,205.61	$1,415.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,003.93 / $1,176.76 / $1,838.91	Professional		$1,003.93	$1,176.76	$1,838.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $185.20 / $249.75 / $368.15	Professional	26	$185.20	$249.75	$368.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $744.30 / $992.40 / $1,627.54	Professional	TC	$744.30	$992.40	$1,627.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $169.54 / $229.74 / $242.76	Facility	26	$169.54	$229.74	$242.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $138.40 / $200.64 / $281.39	Professional	26	$138.40	$200.64	$281.39
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $565.20 / $834.19 / $1,116.27	Professional	TC	$565.20	$834.19	$1,116.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $133.97 / $133.97 / $133.97	Facility	26	$133.97	$133.97	$133.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $834.69 / $1,318.82 / $1,691.40	Professional		$834.69	$1,318.82	$1,691.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $157.63 / $256.81 / $341.23	Professional	26	$157.63	$256.81	$341.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $656.40 / $1,144.83 / $1,440.30	Professional	TC	$656.40	$1,144.83	$1,440.30
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,043.22 / $3,043.22 / $3,043.22	Facility	26	$3,043.22	$3,043.22	$3,043.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $980.10 / $1,209.70 / $1,719.71	Professional		$980.10	$1,209.70	$1,719.71
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $187.38 / $231.28 / $328.78	Professional	26	$187.38	$231.28	$328.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $792.72 / $978.42 / $1,390.93	Professional	TC	$792.72	$978.42	$1,390.93
United Facility/Professional Professional Modifier Low / Median / High Price $923.83 / $1,271.75 / $1,880.33	Professional		$923.83	$1,271.75	$1,880.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $175.95 / $250.15 / $359.50	Professional	26	$175.95	$250.15	$359.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $743.04 / $1,021.60 / $1,506.71	Professional	TC	$743.04	$1,021.60	$1,506.71