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 / $407.38	Facility	26	$104.71	$218.78	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $524.81 / $1,621.81	Professional		$363.08	$524.81	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $204.17 / $537.03	Professional	26	$109.65	$204.17	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $338.84 / $676.08	Professional	TC	$239.88	$338.84	$676.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $676.08 / $1,412.54	Professional		$338.84	$676.08	$1,412.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $169.82 / $331.13	Professional	26	$104.71	$169.82	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $467.74 / $1,174.90	Professional	TC	$234.42	$467.74	$1,174.90
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $707.95 / $891.25	Professional		$616.60	$707.95	$891.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $229.09 / $281.84	Professional	26	$199.53	$229.09	$281.84
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $478.63 / $602.56	Professional	TC	$416.87	$478.63	$602.56
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $208.93 / $407.38	Facility	26	$104.71	$208.93	$407.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $741.31 / $1,348.96	Professional		$524.81	$741.31	$1,348.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $223.87 / $338.84	Professional	26	$138.04	$223.87	$338.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $489.78 / $1,202.26	Professional	TC	$338.84	$489.78	$1,202.26
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $213.80 / $218.78	Facility	26	$177.83	$213.80	$218.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $245.47	Professional	26	$131.83	$190.55	$245.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $478.63 / $954.99	Professional	TC	$316.23	$478.63	$954.99
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $758.58 / $1,148.15	Professional		$363.08	$758.58	$1,148.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $229.09 / $323.59	Professional	26	$107.15	$229.09	$323.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $549.54 / $1,071.52	Professional	TC	$234.42	$549.54	$1,071.52
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 $602.56 / $741.31 / $977.24	Professional		$602.56	$741.31	$977.24
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $229.09 / $295.12	Professional	26	$194.98	$229.09	$295.12
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $512.86 / $676.08	Professional	TC	$407.38	$512.86	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $676.08 / $1,122.02	Professional		$316.23	$676.08	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $144.54 / $316.23	Professional	26	$100.00	$144.54	$316.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $467.74 / $776.25	Professional	TC	$218.78	$467.74	$776.25