Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.42 / $125.04 / $1,267.08	Facility	26	$89.42	$125.04	$1,267.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.81 / $406.68 / $1,013.97	Professional		$302.81	$406.68	$1,013.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $72.70 / $226.00	Professional	26	$51.54	$72.70	$226.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.27 / $316.08 / $730.78	Professional	TC	$251.27	$316.08	$730.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.88 / $63.88 / $63.88	Facility	26	$63.88	$63.88	$63.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $405.33 / $779.86 / $1,084.18	Professional		$405.33	$779.86	$1,084.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.87 / $111.85 / $159.40	Professional	26	$69.87	$111.85	$159.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $342.55 / $672.04 / $939.19	Professional	TC	$342.55	$672.04	$939.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $701.40 / $914.52 / $1,065.40	Professional		$701.40	$914.52	$1,065.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $98.02 / $127.80 / $144.19	Professional	26	$98.02	$127.80	$144.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $603.38 / $784.55 / $921.21	Professional	TC	$603.38	$784.55	$921.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $420.97 / $669.05 / $1,163.01	Professional		$420.97	$669.05	$1,163.01
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.55 / $99.35 / $176.14	Professional	26	$80.55	$99.35	$176.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $249.48 / $579.91 / $1,056.72	Professional	TC	$249.48	$579.91	$1,056.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $109.21 / $111.89	Facility	26	$79.45	$109.21	$111.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $65.53 / $91.77 / $124.29	Professional	26	$65.53	$91.77	$124.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $304.80 / $436.17 / $660.33	Professional	TC	$304.80	$436.17	$660.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $63.88 / $63.88 / $63.88	Facility	26	$63.88	$63.88	$63.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $480.82 / $800.42 / $1,048.05	Professional		$480.82	$800.42	$1,048.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.01 / $116.64 / $159.40	Professional	26	$72.01	$116.64	$159.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $342.55 / $698.34 / $957.47	Professional	TC	$342.55	$698.34	$957.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $589.54 / $762.48 / $1,083.94	Professional		$589.54	$762.48	$1,083.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.10 / $109.97 / $156.34	Professional	26	$89.10	$109.97	$156.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $506.46 / $652.50 / $927.60	Professional	TC	$506.46	$652.50	$927.60
United Facility/Professional Professional Modifier Low / Median / High Price $525.29 / $738.03 / $1,166.96	Professional		$525.29	$738.03	$1,166.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.98 / $118.58 / $170.93	Professional	26	$83.98	$118.58	$170.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $443.92 / $619.60 / $1,014.25	Professional	TC	$443.92	$619.60	$1,014.25