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 / $389.05	Facility	26	$104.71	$218.78	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $1,905.46	Professional		$363.08	$575.44	$1,905.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $158.49 / $457.09	Professional	26	$102.33	$158.49	$457.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $436.52 / $912.01	Professional	TC	$302.00	$436.52	$912.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $831.76 / $1,584.89	Professional		$436.52	$831.76	$1,584.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $144.54 / $295.12	Professional	26	$95.50	$144.54	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $645.65 / $1,318.26	Professional	TC	$331.13	$645.65	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $912.01 / $1,122.02	Professional		$794.33	$912.01	$1,122.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $218.78 / $263.03	Professional	26	$190.55	$218.78	$263.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $691.83 / $870.96	Professional	TC	$588.84	$691.83	$870.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $177.83 / $389.05	Facility	26	$104.71	$177.83	$389.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $870.96 / $1,479.11	Professional		$575.44	$870.96	$1,479.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $204.17 / $302.00	Professional	26	$125.89	$204.17	$302.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $676.08 / $1,288.25	Professional	TC	$436.52	$676.08	$1,288.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $199.53 / $204.17	Facility	26	$154.88	$199.53	$204.17
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $489.78 / $489.78	Professional		$288.40	$489.78	$489.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $181.97 / $213.80	Professional	26	$138.04	$181.97	$213.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $676.08 / $1,096.48	Professional	TC	$512.86	$676.08	$1,096.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $977.24 / $1,380.38	Professional		$467.74	$977.24	$1,380.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $208.93 / $295.12	Professional	26	$100.00	$208.93	$295.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $776.25 / $1,230.27	Professional	TC	$331.13	$776.25	$1,230.27
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 $776.25 / $977.24 / $1,202.26	Professional		$776.25	$977.24	$1,202.26
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $213.80 / $275.42	Professional	26	$181.97	$213.80	$275.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $758.58 / $1,000.00	Professional	TC	$588.84	$758.58	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $812.83 / $1,380.38	Professional		$416.87	$812.83	$1,380.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $125.89 / $295.12	Professional	26	$93.33	$125.89	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $645.65 / $1,096.48	Professional	TC	$323.59	$645.65	$1,096.48