Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $447.41 / $578.48 / $1,086.39	Professional		$447.41	$578.48	$1,086.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.70 / $47.56 / $108.76	Professional	26	$40.70	$47.56	$108.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $400.67 / $439.90 / $977.62	Professional	TC	$400.67	$439.90	$977.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $290.94 / $682.49 / $887.89	Professional		$290.94	$682.49	$887.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.19 / $61.93 / $94.99	Professional	26	$27.19	$61.93	$94.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.75 / $620.55 / $806.95	Professional	TC	$263.75	$620.55	$806.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $534.85 / $1,107.84 / $1,579.09	Professional		$534.85	$1,107.84	$1,579.09
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $54.22 / $112.31 / $160.08	Professional	26	$54.22	$112.31	$160.08
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $480.62 / $995.52 / $1,418.99	Professional	TC	$480.62	$995.52	$1,418.99
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $857.75 / $981.83 / $1,779.24	Professional		$857.75	$981.83	$1,779.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.45 / $98.95 / $179.32	Professional	26	$81.45	$98.95	$179.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $726.81 / $882.90 / $1,599.95	Professional	TC	$726.81	$882.90	$1,599.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $75.45 / $111.89 / $114.24	Facility	26	$75.45	$111.89	$114.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.94 / $108.16 / $113.44	Professional	26	$79.94	$108.16	$113.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $756.79 / $995.53 / $1,108.18	Professional	TC	$756.79	$995.53	$1,108.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $682.49 / $1,176.11 / $1,701.79	Professional		$682.49	$1,176.11	$1,701.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.33 / $61.93 / $96.44	Professional	26	$33.33	$61.93	$96.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $318.77 / $620.55 / $922.23	Professional	TC	$318.77	$620.55	$922.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,066.53 / $1,239.86 / $1,899.26	Professional		$1,066.53	$1,239.86	$1,899.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.15 / $114.32 / $180.12	Professional	26	$101.15	$114.32	$180.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $965.38 / $1,125.55 / $1,719.14	Professional	TC	$965.38	$1,125.55	$1,719.14
United Facility/Professional Professional Modifier Low / Median / High Price $353.60 / $375.79 / $1,878.23	Professional		$353.60	$375.79	$1,878.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.57 / $36.15 / $178.13	Professional	26	$35.57	$36.15	$178.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $317.44 / $529.07 / $1,700.10	Professional	TC	$317.44	$529.07	$1,700.10