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 / $1,143.59	Facility	26	$350.72	$506.97	$1,143.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $427.44 / $601.17 / $1,418.52	Professional		$427.44	$601.17	$1,418.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $195.86 / $295.33 / $933.32	Professional	26	$195.86	$295.33	$933.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.11 / $330.77 / $789.85	Professional	TC	$239.11	$330.77	$789.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $757.78 / $1,035.89 / $1,410.09	Professional		$757.78	$1,035.89	$1,410.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $322.08 / $479.21 / $619.20	Professional	26	$322.08	$479.21	$619.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $423.62 / $567.59 / $805.39	Professional	TC	$423.62	$567.59	$805.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $945.49 / $1,112.93 / $1,280.68	Professional		$945.49	$1,112.93	$1,280.68
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 $508.11 / $586.25 / $688.24	Professional	TC	$508.11	$586.25	$688.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $751.23 / $835.46 / $1,409.04	Professional		$751.23	$835.46	$1,409.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.46 / $517.66 / $722.52	Professional	26	$363.46	$517.66	$722.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $398.15 / $567.05 / $791.46	Professional	TC	$398.15	$567.05	$791.46
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $304.75 / $421.43 / $449.57	Facility	26	$304.75	$421.43	$449.57
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $286.82 / $379.29 / $449.57	Professional	26	$286.82	$379.29	$449.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.82 / $459.02 / $559.59	Professional	TC	$346.82	$459.02	$559.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $794.73 / $1,074.91 / $1,378.65	Professional		$794.73	$1,074.91	$1,378.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $298.07 / $473.88 / $619.20	Professional	26	$298.07	$473.88	$619.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $312.12 / $567.59 / $805.39	Professional	TC	$312.12	$567.59	$805.39
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 $873.18 / $1,112.13 / $1,313.24	Professional		$873.18	$1,112.13	$1,313.24
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $401.00 / $521.03 / $634.82	Professional	26	$401.00	$521.03	$634.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $451.08 / $603.07 / $678.41	Professional	TC	$451.08	$603.07	$678.41
United Facility/Professional Professional Modifier Low / Median / High Price $621.64 / $677.54 / $1,538.47	Professional		$621.64	$677.54	$1,538.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $279.39 / $386.41 / $694.11	Professional	26	$279.39	$386.41	$694.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $331.11 / $361.63 / $761.77	Professional	TC	$331.11	$361.63	$761.77