Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $204.17 / $389.05	Facility	26	$104.71	$204.17	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $537.03 / $1,949.84	Professional		$251.19	$537.03	$1,949.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $165.96 / $457.09	Professional	26	$100.00	$165.96	$457.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $407.38 / $851.14	Professional	TC	$295.12	$407.38	$851.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $812.83 / $1,548.82	Professional		$407.38	$812.83	$1,548.82
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 $309.03 / $616.60 / $1,230.27	Professional	TC	$309.03	$616.60	$1,230.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $851.14 / $1,071.52	Professional		$741.31	$851.14	$1,071.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $218.78 / $263.03	Professional	26	$186.21	$218.78	$263.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $645.65 / $794.33	Professional	TC	$549.54	$645.65	$794.33
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 $562.34 / $831.76 / $1,479.11	Professional		$562.34	$831.76	$1,479.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $204.17 / $302.00	Professional	26	$141.25	$204.17	$302.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $616.60 / $1,380.38	Professional	TC	$407.38	$616.60	$1,380.38
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $199.53 / $204.17	Facility	26	$165.96	$199.53	$204.17
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 $123.03 / $186.21 / $229.09	Professional	26	$123.03	$186.21	$229.09
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $676.08 / $1,023.29	Professional	TC	$426.58	$676.08	$1,023.29
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 $436.52 / $912.01 / $1,318.26	Professional		$436.52	$912.01	$1,318.26
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 $309.03 / $724.44 / $1,174.90	Professional	TC	$309.03	$724.44	$1,174.90
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 $724.44 / $912.01 / $1,174.90	Professional		$724.44	$912.01	$1,174.90
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 $549.54 / $707.95 / $933.25	Professional	TC	$549.54	$707.95	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $776.25 / $1,348.96	Professional		$389.05	$776.25	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $131.83 / $309.03	Professional	26	$93.33	$131.83	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $616.60 / $1,023.29	Professional	TC	$295.12	$616.60	$1,023.29