Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $218.78 / $380.19	Facility	26	$104.71	$218.78	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $524.81 / $1,862.09	Professional		$371.54	$524.81	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $177.83 / $537.03	Professional	26	$102.33	$177.83	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $363.08 / $794.33	Professional	TC	$263.03	$363.08	$794.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $707.95 / $1,479.11	Professional		$363.08	$707.95	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $144.54 / $295.12	Professional	26	$95.50	$144.54	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $524.81 / $1,318.26	Professional	TC	$257.04	$524.81	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $741.31 / $933.25	Professional		$645.65	$741.31	$933.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $213.80 / $263.03	Professional	26	$186.21	$213.80	$263.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $537.03 / $676.08	Professional	TC	$457.09	$537.03	$676.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $204.17 / $380.19	Facility	26	$104.71	$204.17	$380.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $758.58 / $1,445.44	Professional		$524.81	$758.58	$1,445.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $204.17 / $316.23	Professional	26	$128.82	$204.17	$316.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $537.03 / $1,258.93	Professional	TC	$338.84	$537.03	$1,258.93
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $199.53 / $204.17	Facility	26	$165.96	$199.53	$204.17
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $346.74	Professional		$346.74	$346.74	$346.74
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $181.97 / $218.78	Professional	26	$123.03	$181.97	$218.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $588.84 / $1,071.52	Professional	TC	$398.11	$588.84	$1,071.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $851.14 / $1,230.27	Professional		$380.19	$851.14	$1,230.27
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $208.93 / $295.12	Professional	26	$100.00	$208.93	$295.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $645.65 / $1,230.27	Professional	TC	$257.04	$645.65	$1,230.27
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	26	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $812.83 / $1,047.13	Professional		$630.96	$812.83	$1,047.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $213.80 / $275.42	Professional	26	$181.97	$213.80	$275.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $588.84 / $794.33	Professional	TC	$457.09	$588.84	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $707.95 / $1,174.90	Professional		$338.84	$707.95	$1,174.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $125.89 / $295.12	Professional	26	$93.33	$125.89	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $512.86 / $851.14	Professional	TC	$245.47	$512.86	$851.14