Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $407.38 / $794.33	Professional		$316.23	$407.38	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $218.78 / $562.34	Professional	26	$112.20	$218.78	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $549.54	Professional	TC	$213.80	$281.84	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $380.19 / $660.69	Professional		$158.49	$380.19	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $120.23 / $234.42	Professional	26	$64.57	$120.23	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $263.03 / $446.68	Professional	TC	$69.18	$263.03	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $831.76 / $1,174.90	Professional		$407.38	$831.76	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $269.15 / $380.19	Professional	26	$134.90	$269.15	$380.19
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $562.34 / $794.33	Professional	TC	$275.42	$562.34	$794.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $676.08 / $1,348.96	Professional		$338.84	$676.08	$1,348.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $245.47 / $467.74	Professional	26	$144.54	$245.47	$467.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $457.09 / $977.24	Professional	TC	$204.17	$457.09	$977.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $275.42 / $288.40	Facility	26	$208.93	$275.42	$288.40
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $257.04 / $302.00	Professional	26	$190.55	$257.04	$302.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $363.08 / $562.34	Professional	TC	$302.00	$363.08	$562.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $812.83 / $1,318.26	Professional		$338.84	$812.83	$1,318.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $147.91 / $407.38	Professional	26	$85.11	$147.91	$407.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $309.03 / $851.14	Professional	TC	$144.54	$309.03	$851.14
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $851.14 / $1,380.38	Professional		$512.86	$851.14	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $281.84 / $446.68	Professional	26	$165.96	$281.84	$446.68
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $562.34 / $933.25	Professional	TC	$354.81	$562.34	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $426.58 / $1,380.38	Professional		$257.04	$426.58	$1,380.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $147.91 / $446.68	Professional	26	$83.18	$147.91	$446.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $275.42 / $933.25	Professional	TC	$165.96	$275.42	$933.25