Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $164.31 / $236.21 / $533.71	Facility	26	$164.31	$236.21	$533.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $393.25 / $468.27 / $1,112.06	Professional		$393.25	$468.27	$1,112.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.71 / $133.59 / $377.83	Professional	26	$90.71	$133.59	$377.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.52 / $367.81 / $837.94	Professional	TC	$302.52	$367.81	$837.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $702.51 / $944.28 / $1,235.31	Professional		$702.51	$944.28	$1,235.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $150.06 / $223.31 / $287.88	Professional	26	$150.06	$223.31	$287.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $548.32 / $742.46 / $947.43	Professional	TC	$548.32	$742.46	$947.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $812.37 / $948.23 / $1,100.36	Professional		$812.37	$948.23	$1,100.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $203.83 / $244.35 / $276.08	Professional	26	$203.83	$244.35	$276.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $608.54 / $702.00 / $824.29	Professional	TC	$608.54	$702.00	$824.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $683.81 / $731.36 / $1,281.66	Professional		$683.81	$731.36	$1,281.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $169.19 / $240.97 / $336.33	Professional	26	$169.19	$240.97	$336.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $475.55 / $677.29 / $945.33	Professional	TC	$475.55	$677.29	$945.33
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $143.57 / $203.01 / $209.71	Facility	26	$143.57	$203.01	$209.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $116.58 / $165.30 / $209.68	Professional	26	$116.58	$165.30	$209.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $399.19 / $516.57 / $688.76	Professional	TC	$399.19	$516.57	$688.76
Providence Facility/Professional Professional Modifier Low / Median / High Price $712.13 / $988.80 / $1,229.45	Professional		$712.13	$988.80	$1,229.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $139.52 / $219.53 / $287.88	Professional	26	$139.52	$219.53	$287.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $420.84 / $725.44 / $947.43	Professional	TC	$420.84	$725.44	$947.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $778.68 / $1,005.11 / $1,171.10	Professional		$778.68	$1,005.11	$1,171.10
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $186.73 / $243.30 / $295.62	Professional	26	$186.73	$243.30	$295.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $582.12 / $748.30 / $875.49	Professional	TC	$582.12	$748.30	$875.49
United Facility/Professional Professional Modifier Low / Median / High Price $576.08 / $593.51 / $1,314.99	Professional		$576.08	$593.51	$1,314.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $130.27 / $140.25 / $323.24	Professional	26	$130.27	$140.25	$323.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $439.39 / $763.79 / $1,006.72	Professional	TC	$439.39	$763.79	$1,006.72