Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $350.72 / $506.97 / $1,141.77	Facility	26	$350.72	$506.97	$1,141.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $504.95 / $620.39 / $2,300.52	Professional		$504.95	$620.39	$2,300.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $198.28 / $285.14 / $1,036.40	Professional	26	$198.28	$285.14	$1,036.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $306.66 / $348.92 / $1,392.30	Professional	TC	$306.66	$348.92	$1,392.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $766.43 / $1,118.82 / $1,418.03	Professional		$766.43	$1,118.82	$1,418.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $337.66 / $479.21 / $642.53	Professional	26	$337.66	$479.21	$642.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $428.77 / $606.00 / $759.17	Professional	TC	$428.77	$606.00	$759.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $967.63 / $1,138.40 / $1,310.67	Professional		$967.63	$1,138.40	$1,310.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $437.40 / $524.58 / $592.47	Professional	26	$437.40	$524.58	$592.47
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $530.25 / $611.78 / $718.23	Professional	TC	$530.25	$611.78	$718.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $667.59 / $834.21 / $1,547.96	Professional		$667.59	$834.21	$1,547.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.46 / $453.04 / $722.52	Professional	26	$363.46	$453.04	$722.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $440.41 / $591.40 / $834.21	Professional	TC	$440.41	$591.40	$834.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $304.75 / $421.43 / $448.90	Facility	26	$304.75	$421.43	$448.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $364.38 / $364.38 / $404.87	Professional		$364.38	$364.38	$404.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $264.52 / $377.40 / $446.59	Professional	26	$264.52	$377.40	$446.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $311.60 / $430.60 / $613.74	Professional	TC	$311.60	$430.60	$613.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $798.86 / $1,094.71 / $1,398.74	Professional		$798.86	$1,094.71	$1,398.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $298.07 / $432.94 / $619.20	Professional	26	$298.07	$432.94	$619.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $333.86 / $549.76 / $754.83	Professional	TC	$333.86	$549.76	$754.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,999.35 / $3,999.35 / $3,999.35	Facility	26	$3,999.35	$3,999.35	$3,999.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $861.79 / $1,119.77 / $1,353.98	Professional		$861.79	$1,119.77	$1,353.98
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $404.01 / $520.77 / $634.82	Professional	26	$404.01	$520.77	$634.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $464.28 / $599.46 / $719.15	Professional	TC	$464.28	$599.46	$719.15
United Facility/Professional Professional Modifier Low / Median / High Price $614.46 / $686.63 / $1,520.32	Professional		$614.46	$686.63	$1,520.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $279.39 / $365.93 / $712.80	Professional	26	$279.39	$365.93	$712.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $332.02 / $353.99 / $842.50	Professional	TC	$332.02	$353.99	$842.50