Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.92 / $264.51 / $534.40	Facility	26	$127.92	$264.51	$534.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $603.00 / $2,650.00	Professional		$475.00	$603.00	$2,650.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.00 / $140.00 / $322.00	Professional	26	$104.00	$140.00	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $305.00 / $440.00 / $986.93	Professional	TC	$305.00	$440.00	$986.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $525.24 / $1,035.57 / $1,595.03	Professional		$525.24	$1,035.57	$1,595.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.85 / $192.03 / $308.33	Professional	26	$105.85	$192.03	$308.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $417.28 / $828.28 / $1,358.11	Professional	TC	$417.28	$828.28	$1,358.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $940.92 / $1,087.90 / $1,298.83	Professional		$940.92	$1,087.90	$1,298.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $204.24 / $235.11 / $274.81	Professional	26	$204.24	$235.11	$274.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $730.39 / $853.77 / $1,024.02	Professional	TC	$730.39	$853.77	$1,024.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $784.69 / $992.50 / $1,513.98	Professional		$784.69	$992.50	$1,513.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $170.79 / $214.35 / $325.32	Professional	26	$170.79	$214.35	$325.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $590.83 / $841.49 / $1,504.15	Professional	TC	$590.83	$841.49	$1,504.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $158.27 / $210.53 / $216.41	Facility	26	$158.27	$210.53	$216.41
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $268.35 / $268.35 / $268.35	Professional		$268.35	$268.35	$268.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $128.63 / $190.20 / $224.42	Professional	26	$128.63	$190.20	$224.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $542.70 / $768.83 / $1,098.90	Professional	TC	$542.70	$768.83	$1,098.90
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $122.33 / $122.33 / $122.33	Facility	26	$122.33	$122.33	$122.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $796.37 / $1,172.16 / $1,484.03	Professional		$796.37	$1,172.16	$1,484.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.70 / $192.33 / $311.73	Professional	26	$109.70	$192.33	$311.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $417.28 / $821.92 / $1,289.39	Professional	TC	$417.28	$821.92	$1,289.39
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,538.06 / $1,538.06 / $1,538.06	Facility	26	$1,538.06	$1,538.06	$1,538.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $888.17 / $1,165.53 / $1,406.09	Professional		$888.17	$1,165.53	$1,406.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $191.52 / $227.11 / $303.20	Professional	26	$191.52	$227.11	$303.20
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $696.65 / $914.21 / $1,187.18	Professional	TC	$696.65	$914.21	$1,187.18
United Facility/Professional Professional Modifier Low / Median / High Price $477.94 / $885.26 / $1,595.40	Professional		$477.94	$885.26	$1,595.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.55 / $165.36 / $342.92	Professional	26	$97.55	$165.36	$342.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.39 / $644.80 / $1,281.69	Professional	TC	$380.39	$644.80	$1,281.69