Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $239.88 / $407.38	Facility	26	$173.78	$239.88	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $630.96 / $2,398.83	Professional		$426.58	$630.96	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $154.88 / $380.19	Professional	26	$107.15	$154.88	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $446.68 / $891.25	Professional	TC	$338.84	$446.68	$891.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $954.99 / $1,737.80	Professional		$501.19	$954.99	$1,737.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $154.88 / $309.03	Professional	26	$100.00	$154.88	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $741.31 / $1,513.56	Professional	TC	$398.11	$741.31	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,047.13 / $1,288.25	Professional		$891.25	$1,047.13	$1,288.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $229.09 / $275.42	Professional	26	$194.98	$229.09	$275.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $812.83 / $1,023.29	Professional	TC	$707.95	$812.83	$1,023.29
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $213.80 / $407.38	Facility	26	$104.71	$213.80	$407.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,023.29 / $1,698.24	Professional		$630.96	$1,023.29	$1,698.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $213.80 / $316.23	Professional	26	$141.25	$213.80	$316.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $794.33 / $1,513.56	Professional	TC	$467.74	$794.33	$1,513.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $208.93 / $218.78	Facility	26	$173.78	$208.93	$218.78
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $436.52 / $436.52	Professional		$436.52	$436.52	$436.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $190.55 / $229.09	Professional	26	$128.82	$190.55	$229.09
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $794.33 / $1,230.27	Professional	TC	$537.03	$794.33	$1,230.27
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $123.03 / $173.78	Facility	26	$26.30	$123.03	$173.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $1,096.48 / $1,584.89	Professional		$537.03	$1,096.48	$1,584.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $218.78 / $309.03	Professional	26	$104.71	$218.78	$309.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $933.25 / $1,412.54	Professional	TC	$398.11	$933.25	$1,412.54
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 $891.25 / $1,122.02 / $1,380.38	Professional		$891.25	$1,122.02	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $223.87 / $288.40	Professional	26	$190.55	$223.87	$288.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $891.25 / $1,174.90	Professional	TC	$691.83	$891.25	$1,174.90
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $891.25 / $1,584.89	Professional		$478.63	$891.25	$1,584.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $131.83 / $309.03	Professional	26	$97.72	$131.83	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $758.58 / $1,288.25	Professional	TC	$380.19	$758.58	$1,288.25