Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $412.61 / $412.61 / $456.30	Facility	26	$412.61	$412.61	$456.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.05 / $364.48 / $1,274.00	Professional		$288.05	$364.48	$1,274.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $171.18 / $200.50 / $507.53	Professional	26	$171.18	$200.50	$507.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.57 / $128.43 / $229.28	Professional	TC	$99.57	$128.43	$229.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $208.62 / $208.62 / $208.62	Facility	26	$208.62	$208.62	$208.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $393.13 / $621.97 / $839.81	Professional		$393.13	$621.97	$839.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $240.34 / $384.59 / $522.23	Professional	26	$240.34	$384.59	$522.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.02 / $237.67 / $319.64	Professional	TC	$147.02	$237.67	$319.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $506.21 / $660.02 / $754.53	Professional		$506.21	$660.02	$754.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $323.36 / $421.62 / $475.48	Professional	26	$323.36	$421.62	$475.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $182.84 / $237.68 / $279.05	Professional	TC	$182.84	$237.68	$279.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $453.67 / $542.73 / $865.14	Professional		$453.67	$542.73	$865.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $292.48 / $354.52 / $581.41	Professional	26	$292.48	$354.52	$581.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.19 / $195.38 / $320.42	Professional	TC	$161.19	$195.38	$320.42
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $259.69 / $359.12 / $365.15	Facility	26	$259.69	$359.12	$365.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $216.68 / $307.23 / $388.08	Professional	26	$216.68	$307.23	$388.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $129.04 / $186.39 / $229.02	Professional	TC	$129.04	$186.39	$229.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $208.62 / $208.62 / $208.62	Facility	26	$208.62	$208.62	$208.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $390.49 / $619.20 / $808.83	Professional		$390.49	$619.20	$808.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $247.34 / $384.59 / $522.23	Professional	26	$247.34	$384.59	$522.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $143.15 / $237.67 / $320.07	Professional	TC	$143.15	$237.67	$320.07
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 $459.54 / $583.50 / $806.32	Professional		$459.54	$583.50	$806.32
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $293.76 / $362.58 / $515.44	Professional	26	$293.76	$362.58	$515.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.78 / $223.03 / $290.88	Professional	TC	$165.78	$223.03	$290.88
United Facility/Professional Professional Modifier Low / Median / High Price $433.16 / $610.21 / $896.95	Professional		$433.16	$610.21	$896.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $276.89 / $388.37 / $573.39	Professional	26	$276.89	$388.37	$573.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $156.26 / $228.90 / $326.61	Professional	TC	$156.26	$228.90	$326.61