Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.18 / $273.07 / $333.14	Facility	26	$199.18	$273.07	$333.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $637.00 / $848.36 / $3,270.00	Professional		$637.00	$848.36	$3,270.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.20 / $171.66 / $576.00	Professional	26	$123.20	$171.66	$576.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $296.98 / $399.19 / $840.46	Professional	52	$296.98	$399.19	$840.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $516.63 / $695.51 / $1,433.51	Professional	TC	$516.63	$695.51	$1,433.51
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $891.75 / $1,442.67 / $1,827.74	Professional		$891.75	$1,442.67	$1,827.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $172.36 / $259.08 / $355.00	Professional	26	$172.36	$259.08	$355.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $718.96 / $1,172.43 / $1,510.05	Professional	TC	$718.96	$1,172.43	$1,510.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,185.94 / $1,546.30 / $1,796.09	Professional		$1,185.94	$1,546.30	$1,796.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $213.12 / $277.27 / $312.17	Professional	26	$213.12	$277.27	$312.17
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $972.82 / $1,263.99 / $1,483.92	Professional	TC	$972.82	$1,263.99	$1,483.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,051.43 / $1,234.42 / $1,882.91	Professional		$1,051.43	$1,234.42	$1,882.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $193.20 / $264.86 / $384.06	Professional	26	$193.20	$264.86	$384.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $780.20 / $1,075.90 / $1,706.03	Professional	TC	$780.20	$1,075.90	$1,706.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $176.40 / $239.29 / $252.96	Facility	26	$176.40	$239.29	$252.96
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $144.72 / $205.20 / $284.39	Professional	26	$144.72	$205.20	$284.39
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $601.60 / $854.93 / $1,104.00	Professional	TC	$601.60	$854.93	$1,104.00
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $872.03 / $1,384.58 / $1,765.55	Professional		$872.03	$1,384.58	$1,765.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $163.53 / $268.47 / $355.60	Professional	26	$163.53	$268.47	$355.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $686.30 / $1,200.27 / $1,510.05	Professional	TC	$686.30	$1,200.27	$1,510.05
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 $1,025.46 / $1,265.68 / $1,799.30	Professional		$1,025.46	$1,265.68	$1,799.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $194.40 / $239.94 / $341.10	Professional	26	$194.40	$239.94	$341.10
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $831.06 / $1,025.74 / $1,458.20	Professional	TC	$831.06	$1,025.74	$1,458.20
United Facility/Professional Professional Modifier Low / Median / High Price $966.59 / $1,336.10 / $1,967.37	Professional		$966.59	$1,336.10	$1,967.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $193.32 / $260.98 / $379.43	Professional	26	$193.32	$260.98	$379.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $777.60 / $1,036.80 / $1,576.80	Professional	TC	$777.60	$1,036.80	$1,576.80