Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.86 / $74.86 / $111.18	Facility	26	$74.86	$74.86	$111.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $292.89 / $379.85 / $688.07	Professional		$292.89	$379.85	$688.07
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $161.57 / $205.30 / $481.84	Professional	52	$161.57	$205.30	$481.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $252.77 / $329.91 / $618.57	Professional	TC	$252.77	$329.91	$618.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.88 / $50.88 / $50.88	Facility	26	$50.88	$50.88	$50.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $411.45 / $765.10 / $1,043.45	Professional		$411.45	$765.10	$1,043.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $356.65 / $661.58 / $926.12	Professional	TC	$356.65	$661.58	$926.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $674.54 / $879.51 / $1,025.39	Professional		$674.54	$879.51	$1,025.39
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.44 / $102.28 / $115.30	Professional	26	$78.44	$102.28	$115.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $596.10 / $775.08 / $910.09	Professional	TC	$596.10	$775.08	$910.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $556.16 / $643.13 / $1,106.07	Professional		$556.16	$643.13	$1,106.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $525.17 / $636.58 / $1,043.99	Professional	TC	$525.17	$636.58	$1,043.99
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.95 / $87.75 / $89.11	Facility	26	$63.95	$87.75	$89.11
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $371.85 / $532.75 / $649.13	Professional	TC	$371.85	$532.75	$649.13
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $50.88 / $50.88 / $50.88	Facility	26	$50.88	$50.88	$50.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $491.09 / $766.26 / $1,000.96	Professional		$491.09	$766.26	$1,000.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $356.65 / $689.65 / $932.97	Professional	TC	$356.65	$689.65	$932.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,497.68 / $1,497.68 / $1,497.68	Facility	26	$1,497.68	$1,497.68	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $559.69 / $725.15 / $1,030.88	Professional		$559.69	$725.15	$1,030.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $493.52 / $637.16 / $905.81	Professional	TC	$493.52	$637.16	$905.81
United Facility/Professional Professional Modifier Low / Median / High Price $533.53 / $700.58 / $1,107.75	Professional		$533.53	$700.58	$1,107.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $462.25 / $599.21 / $976.19	Professional	TC	$462.25	$599.21	$976.19