Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $158.49 / $263.03	Facility	26	$112.20	$158.49	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $524.81 / $1,047.13	Professional		$363.08	$524.81	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $141.25 / $257.04	Professional	26	$72.44	$141.25	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $363.08 / $794.33	Professional	TC	$269.15	$363.08	$794.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $741.31 / $1,659.59	Professional		$354.81	$741.31	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $117.49 / $234.42	Professional	26	$69.18	$117.49	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $645.65 / $1,479.11	Professional	TC	$281.84	$645.65	$1,479.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $724.44 / $912.01	Professional		$630.96	$724.44	$912.01
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $147.91 / $177.83	Professional	26	$128.82	$147.91	$177.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $588.84 / $741.31	Professional	TC	$501.19	$588.84	$741.31
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $138.04 / $263.03	Facility	26	$128.82	$138.04	$263.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $776.25 / $1,479.11	Professional		$537.03	$776.25	$1,479.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $151.36 / $218.78	Professional	26	$112.20	$151.36	$218.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $602.56 / $1,412.54	Professional	TC	$371.54	$602.56	$1,412.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $138.04 / $173.78	Facility	26	$114.82	$138.04	$173.78
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $645.65 / $645.65	Professional		$489.78	$645.65	$645.65
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $173.78	Professional	26	$102.33	$147.91	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $831.76 / $1,230.27	Professional	TC	$478.63	$831.76	$1,230.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $851.14 / $1,412.54	Professional		$371.54	$851.14	$1,412.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $162.18 / $218.78	Professional	26	$69.18	$162.18	$218.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $741.31 / $1,584.89	Professional	TC	$281.84	$741.31	$1,584.89
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 $616.60 / $831.76 / $1,202.26	Professional		$616.60	$831.76	$1,202.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $154.88 / $190.55	Professional	26	$125.89	$154.88	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $660.69 / $1,000.00	Professional	TC	$489.78	$660.69	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $676.08 / $1,258.93	Professional		$323.59	$676.08	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $213.80	Professional	26	$64.57	$93.33	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $549.54 / $1,122.02	Professional	TC	$257.04	$549.54	$1,122.02