Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $865.49 / $4,704.00 / $8,728.00	Facility		$865.49	$4,704.00	$8,728.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $253.20 / $275.30 / $305.08	Facility	26	$253.20	$275.30	$305.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $341.43 / $527.88 / $990.54	Professional		$341.43	$527.88	$990.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.70 / $163.75 / $382.33	Professional	26	$125.70	$163.75	$382.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.11 / $341.24 / $720.00	Professional	TC	$214.11	$341.24	$720.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $505.18 / $895.57 / $1,131.86	Professional		$505.18	$895.57	$1,131.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $183.08 / $280.86 / $408.43	Professional	26	$183.08	$280.86	$408.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.11 / $601.62 / $768.02	Professional	TC	$322.11	$601.62	$768.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $587.39 / $838.80 / $966.93	Professional		$587.39	$838.80	$966.93
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $198.92 / $281.35 / $316.77	Professional	26	$198.92	$281.35	$316.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $394.94 / $553.70 / $650.13	Professional	TC	$394.94	$553.70	$650.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $540.72 / $729.46 / $1,162.55	Facility		$540.72	$729.46	$1,162.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $520.71 / $609.09 / $1,141.59	Professional		$520.71	$609.09	$1,141.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $199.07 / $283.52 / $395.73	Professional	26	$199.07	$283.52	$395.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $375.21 / $534.39 / $745.87	Professional	TC	$375.21	$534.39	$745.87
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $468.51 / $660.78 / $771.17	Facility		$468.51	$660.78	$771.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $176.84 / $242.33 / $247.90	Facility	26	$176.84	$242.33	$247.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $319.13 / $323.00 / $354.59	Professional		$319.13	$323.00	$354.59
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $146.72 / $220.70 / $255.27	Professional	26	$146.72	$220.70	$255.27
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $242.00 / $370.50 / $473.48	Professional	TC	$242.00	$370.50	$473.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $540.72 / $829.17 / $1,162.55	Facility		$540.72	$829.17	$1,162.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $623.38 / $915.05 / $1,131.86	Professional		$623.38	$915.05	$1,131.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $191.93 / $280.86 / $363.85	Professional	26	$191.93	$280.86	$363.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $337.68 / $601.62 / $768.02	Professional	TC	$337.68	$601.62	$768.02
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,568.64 / $2,136.85 / $2,599.42	Facility		$1,568.64	$2,136.85	$2,599.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,906.19 / $1,906.19 / $1,906.19	Facility	26	$1,906.19	$1,906.19	$1,906.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $712.21 / $944.40 / $1,207.40	Professional		$712.21	$944.40	$1,207.40
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $226.95 / $303.58 / $388.13	Professional	26	$226.95	$303.58	$388.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $485.26 / $640.80 / $819.27	Professional	TC	$485.26	$640.80	$819.27
United Facility/Professional Facility Modifier Low / Median / High Price $1,106.00 / $2,385.00 / $7,480.00	Facility		$1,106.00	$2,385.00	$7,480.00
United Facility/Professional Professional Modifier Low / Median / High Price $565.52 / $884.02 / $1,231.98	Professional		$565.52	$884.02	$1,231.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $186.67 / $265.73 / $392.57	Professional	26	$186.67	$265.73	$392.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $371.53 / $469.67 / $839.41	Professional	TC	$371.53	$469.67	$839.41