Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $451.38 / $551.40 / $624.85	Facility	26	$451.38	$551.40	$624.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,068.84 / $1,487.23 / $4,933.00	Professional		$1,068.84	$1,487.23	$4,933.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $289.42 / $388.02 / $1,429.00	Professional	26	$289.42	$388.02	$1,429.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $779.44 / $1,120.25 / $2,045.07	Professional	TC	$779.44	$1,120.25	$2,045.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,327.21 / $2,364.27 / $3,033.71	Professional		$1,327.21	$2,364.27	$3,033.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $392.09 / $634.50 / $844.72	Professional	26	$392.09	$634.50	$844.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $935.12 / $1,729.77 / $2,285.13	Professional	TC	$935.12	$1,729.77	$2,285.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,598.18 / $2,319.94 / $2,706.94	Professional		$1,598.18	$2,319.94	$2,706.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $449.98 / $636.12 / $724.14	Professional	26	$449.98	$636.12	$724.14
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,148.19 / $1,670.09 / $1,982.80	Professional	TC	$1,148.19	$1,670.09	$1,982.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,588.88 / $2,099.25 / $3,158.51	Professional		$1,588.88	$2,099.25	$3,158.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $457.92 / $652.20 / $910.30	Professional	26	$457.92	$652.20	$910.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,130.94 / $1,610.74 / $2,248.17	Professional	TC	$1,130.94	$1,610.74	$2,248.17
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $419.09 / $548.16 / $590.85	Facility	26	$419.09	$548.16	$590.85
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,039.70 / $2,039.70 / $3,060.71	Professional		$2,039.70	$2,039.70	$3,060.71
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $346.00 / $517.72 / $609.83	Professional	26	$346.00	$517.72	$609.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $805.60 / $1,215.11 / $1,485.39	Professional	TC	$805.60	$1,215.11	$1,485.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,797.62 / $2,492.00 / $3,208.45	Professional		$1,797.62	$2,492.00	$3,208.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $390.49 / $634.50 / $844.72	Professional	26	$390.49	$634.50	$844.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,064.55 / $1,729.77 / $2,285.13	Professional	TC	$1,064.55	$1,729.77	$2,285.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $9,482.39 / $9,482.39 / $9,482.39	Facility	26	$9,482.39	$9,482.39	$9,482.39
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,972.34 / $2,520.35 / $3,319.97	Professional		$1,972.34	$2,520.35	$3,319.97
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $541.37 / $691.78 / $911.26	Professional	26	$541.37	$691.78	$911.26
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,430.98 / $1,819.05 / $2,408.71	Professional	TC	$1,430.98	$1,819.05	$2,408.71
United Facility/Professional Professional Modifier Low / Median / High Price $1,581.32 / $2,128.69 / $3,283.22	Professional		$1,581.32	$2,128.69	$3,283.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $452.16 / $683.12 / $909.65	Professional	26	$452.16	$683.12	$909.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,136.19 / $1,543.69 / $2,382.04	Professional	TC	$1,136.19	$1,543.69	$2,382.04