Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $350.63 / $393.75 / $766.67	Professional		$350.63	$393.75	$766.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.22 / $42.60 / $89.94	Professional	26	$37.22	$42.60	$89.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $310.24 / $351.13 / $676.73	Professional	TC	$310.24	$351.13	$676.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.42 / $510.60 / $711.87	Professional		$185.42	$510.60	$711.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $53.24 / $81.42	Professional	26	$22.87	$53.24	$81.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.55 / $455.28 / $627.41	Professional	TC	$162.55	$455.28	$627.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $387.84 / $803.34 / $1,145.06	Professional		$387.84	$803.34	$1,145.06
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $45.20 / $93.62 / $133.44	Professional	26	$45.20	$93.62	$133.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $342.63 / $709.70 / $1,011.58	Professional	TC	$342.63	$709.70	$1,011.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $648.99 / $770.80 / $1,290.11	Professional		$648.99	$770.80	$1,290.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.95 / $82.55 / $149.60	Professional	26	$67.95	$82.55	$149.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $518.10 / $629.37 / $1,140.52	Professional	TC	$518.10	$629.37	$1,140.52
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $70.25 / $93.63 / $97.15	Facility	26	$70.25	$93.63	$97.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $58.29 / $79.45 / $102.58	Professional	26	$58.29	$79.45	$102.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $562.00 / $709.71 / $863.46	Professional	TC	$562.00	$709.71	$863.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $495.48 / $872.44 / $1,226.96	Professional		$495.48	$872.44	$1,226.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.09 / $53.24 / $84.45	Professional	26	$29.09	$53.24	$84.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $284.02 / $515.94 / $656.34	Professional	TC	$284.02	$515.94	$656.34
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $749.32 / $892.35 / $1,343.54	Professional		$749.32	$892.35	$1,343.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.79 / $94.76 / $149.52	Professional	26	$83.79	$94.76	$149.52
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $665.53 / $797.59 / $1,194.02	Professional	TC	$665.53	$797.59	$1,194.02
United Facility/Professional Professional Modifier Low / Median / High Price $270.24 / $334.18 / $1,319.62	Professional		$270.24	$334.18	$1,319.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.53 / $50.89 / $147.56	Professional	26	$30.53	$50.89	$147.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.71 / $395.67 / $1,172.06	Professional	TC	$239.71	$395.67	$1,172.06