Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.60 / $376.72 / $1,153.07	Professional		$226.60	$376.72	$1,153.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.84 / $64.26 / $178.30	Professional	26	$38.84	$64.26	$178.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.35 / $320.55 / $849.46	Professional	TC	$146.35	$320.55	$849.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.43 / $437.54 / $573.53	Professional		$106.43	$437.54	$573.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.15 / $68.16 / $101.75	Professional	26	$32.15	$68.16	$101.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.45 / $369.38 / $488.85	Professional	TC	$72.45	$369.38	$488.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.11 / $768.69 / $1,095.67	Professional		$371.11	$768.69	$1,095.67
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $60.16 / $124.61 / $177.62	Professional	26	$60.16	$124.61	$177.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $310.95 / $644.08 / $918.05	Professional	TC	$310.95	$644.08	$918.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $560.52 / $707.42 / $1,233.90	Professional		$560.52	$707.42	$1,233.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.13 / $109.49 / $198.41	Professional	26	$90.13	$109.49	$198.41
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $470.39 / $571.41 / $1,035.50	Professional	TC	$470.39	$571.41	$1,035.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $75.17 / $123.95 / $125.29	Facility	26	$75.17	$123.95	$125.29
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.40 / $123.95 / $127.41	Professional	26	$81.40	$123.95	$127.41
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $536.76 / $641.19 / $670.67	Professional	TC	$536.76	$641.19	$670.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $418.60 / $767.65 / $1,150.42	Professional		$418.60	$767.65	$1,150.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.97 / $68.16 / $107.98	Professional	26	$36.97	$68.16	$107.98
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.32 / $369.38 / $513.96	Professional	TC	$144.32	$369.38	$513.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $706.83 / $829.63 / $1,266.65	Professional		$706.83	$829.63	$1,266.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $110.72 / $126.11 / $197.58	Professional	26	$110.72	$126.11	$197.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $596.11 / $703.51 / $1,069.07	Professional	TC	$596.11	$703.51	$1,069.07
United Facility/Professional Professional Modifier Low / Median / High Price $247.06 / $366.37 / $1,244.78	Professional		$247.06	$366.37	$1,244.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.46 / $40.50 / $194.99	Professional	26	$39.46	$40.50	$194.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $206.57 / $344.29 / $1,049.79	Professional	TC	$206.57	$344.29	$1,049.79