Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $371.54 / $512.86 / $588.84	Facility	26	$371.54	$512.86	$588.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $616.60 / $2,238.72	Professional		$489.78	$616.60	$2,238.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $380.19 / $1,047.13	Professional	26	$208.93	$380.19	$1,047.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $346.74 / $758.58	Professional	TC	$245.47	$346.74	$758.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,122.02 / $1,548.82	Professional		$691.83	$1,122.02	$1,548.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $316.23 / $478.63 / $660.69	Professional	26	$316.23	$478.63	$660.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $602.56 / $933.25	Professional	TC	$380.19	$602.56	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $1,122.02 / $1,318.26	Professional		$524.81	$1,122.02	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $512.86 / $602.56	Professional	26	$234.42	$512.86	$602.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $602.56 / $724.44	Professional	TC	$288.40	$602.56	$724.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $288.40 / $467.74 / $537.03	Facility	26	$288.40	$467.74	$537.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $912.01 / $1,621.81	Professional		$616.60	$912.01	$1,621.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $457.09 / $724.44	Professional	26	$239.88	$457.09	$724.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $602.56 / $831.76	Professional	TC	$346.74	$602.56	$831.76
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $416.87 / $446.68	Facility	26	$354.81	$416.87	$446.68
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $354.81 / $446.68	Professional	26	$263.03	$354.81	$446.68
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $426.58 / $588.84	Professional	TC	$302.00	$426.58	$588.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,047.13 / $1,380.38	Professional		$758.58	$1,047.13	$1,380.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $457.09 / $660.69	Professional	26	$331.13	$457.09	$660.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $575.44 / $758.58	Professional	TC	$398.11	$575.44	$758.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,981.07 / $3,981.07 / $3,981.07	Facility	26	$3,981.07	$3,981.07	$3,981.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,000.00 / $1,258.93	Professional		$870.96	$1,000.00	$1,258.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $398.11 / $467.74 / $602.56	Professional	26	$398.11	$467.74	$602.56
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $524.81 / $676.08	Professional	TC	$467.74	$524.81	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $776.25 / $1,412.54	Professional		$616.60	$776.25	$1,412.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $288.40 / $645.65	Professional	26	$269.15	$288.40	$645.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $524.81 / $851.14	Professional	TC	$331.13	$524.81	$851.14