Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $181.97 / $213.80	Facility	26	$104.71	$181.97	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $870.96	Professional		$281.84	$478.63	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $141.25 / $446.68	Professional	26	$83.18	$141.25	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $338.84 / $562.34	Professional	TC	$199.53	$338.84	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $562.34 / $1,122.02	Professional		$288.40	$562.34	$1,122.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $125.89 / $251.19	Professional	26	$79.43	$125.89	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $416.87 / $954.99	Professional	TC	$204.17	$416.87	$954.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $602.56 / $741.31	Professional		$524.81	$602.56	$741.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $177.83 / $218.78	Professional	26	$154.88	$177.83	$218.78
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $426.58 / $524.81	Professional	TC	$363.08	$426.58	$524.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $630.96 / $1,023.29	Professional		$457.09	$630.96	$1,023.29
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $169.82 / $251.19	Professional	26	$134.90	$169.82	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $436.52 / $870.96	Professional	TC	$316.23	$436.52	$870.96
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $169.82	Facility	26	$138.04	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Professional		$295.12	$295.12	$295.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $151.36 / $177.83	Professional	26	$102.33	$151.36	$177.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $407.38 / $758.58	Professional	TC	$269.15	$407.38	$758.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $630.96 / $1,000.00	Professional		$302.00	$630.96	$1,000.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $173.78 / $251.19	Professional	26	$83.18	$173.78	$251.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $478.63 / $912.01	Professional	TC	$204.17	$478.63	$912.01
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 $501.19 / $630.96 / $831.76	Professional		$501.19	$630.96	$831.76
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $177.83 / $229.09	Professional	26	$151.36	$177.83	$229.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $446.68 / $588.84	Professional	TC	$354.81	$446.68	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $537.03 / $912.01	Professional		$269.15	$537.03	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $107.15 / $245.47	Professional	26	$77.62	$107.15	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $407.38 / $660.69	Professional	TC	$190.55	$407.38	$660.69