Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $320.72 / $378.24 / $770.27	Facility	26	$320.72	$378.24	$770.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $317.47 / $375.78 / $1,243.07	Professional		$317.47	$375.78	$1,243.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $140.26 / $378.24	Professional	26	$131.81	$140.26	$378.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $215.52 / $772.40	Professional	TC	$185.65	$215.52	$772.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $529.19 / $920.60 / $1,282.36	Professional		$529.19	$920.60	$1,282.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $217.10 / $324.01 / $417.98	Professional	26	$217.10	$324.01	$417.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $312.10 / $578.70 / $869.36	Professional	TC	$312.10	$578.70	$869.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $930.35 / $1,089.47 / $1,260.17	Professional		$930.35	$1,089.47	$1,260.17
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $295.73 / $354.85 / $400.58	Professional	26	$295.73	$354.85	$400.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $634.62 / $732.17 / $859.60	Professional	TC	$634.62	$732.17	$859.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $647.91 / $814.97 / $1,476.85	Professional		$647.91	$814.97	$1,476.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $246.05 / $350.43 / $489.11	Professional	26	$246.05	$350.43	$489.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $496.90 / $707.70 / $987.77	Professional	TC	$496.90	$707.70	$987.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $206.40 / $285.42 / $302.83	Facility	26	$206.40	$285.42	$302.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $223.80 / $248.67 / $248.67	Professional		$223.80	$248.67	$248.67
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $181.70 / $248.60 / $302.83	Professional	26	$181.70	$248.60	$302.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $297.82 / $509.30 / $620.41	Professional	TC	$297.82	$509.30	$620.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $590.59 / $1,019.30 / $1,336.66	Professional		$590.59	$1,019.30	$1,336.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $201.13 / $318.70 / $417.98	Professional	26	$201.13	$318.70	$417.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $327.18 / $578.33 / $874.74	Professional	TC	$327.18	$578.33	$874.74
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,088.88 / $1,088.88 / $1,088.88	Facility	26	$1,088.88	$1,088.88	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $795.22 / $1,070.00 / $1,291.44	Professional		$795.22	$1,070.00	$1,291.44
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $270.52 / $351.52 / $428.27	Professional	26	$270.52	$351.52	$428.27
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $507.15 / $692.40 / $863.17	Professional	TC	$507.15	$692.40	$863.17
United Facility/Professional Professional Modifier Low / Median / High Price $443.33 / $521.95 / $1,450.09	Professional		$443.33	$521.95	$1,450.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $189.10 / $198.61 / $480.89	Professional	26	$189.10	$198.61	$480.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $254.23 / $325.70 / $969.20	Professional	TC	$254.23	$325.70	$969.20