Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $127.66 / $185.23 / $417.33	Facility	26	$127.66	$185.23	$417.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $481.64 / $651.26 / $2,470.65	Professional		$481.64	$651.26	$2,470.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.31 / $103.79 / $380.00	Professional	26	$70.31	$103.79	$380.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $413.91 / $547.47 / $1,811.00	Professional	TC	$413.91	$547.47	$1,811.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $782.10 / $1,051.27 / $1,454.10	Professional		$782.10	$1,051.27	$1,454.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.64 / $174.58 / $225.32	Professional	26	$117.64	$174.58	$225.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $658.82 / $892.10 / $1,228.58	Professional	TC	$658.82	$892.10	$1,228.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $893.05 / $1,039.65 / $1,209.65	Professional		$893.05	$1,039.65	$1,209.65
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $159.36 / $191.07 / $215.85	Professional	26	$159.36	$191.07	$215.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $733.69 / $846.34 / $993.80	Professional	TC	$733.69	$846.34	$993.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $748.34 / $805.86 / $1,376.49	Professional		$748.34	$805.86	$1,376.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $132.36 / $188.52 / $263.12	Professional	26	$132.36	$188.52	$263.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $573.21 / $816.39 / $1,139.47	Professional	TC	$573.21	$816.39	$1,139.47
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.21 / $154.10 / $164.15	Facility	26	$112.21	$154.10	$164.15
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $223.80 / $223.80 / $223.80	Professional		$223.80	$223.80	$223.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $104.88 / $139.53 / $183.75	Professional	26	$104.88	$139.53	$183.75
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $522.24 / $714.00 / $889.38	Professional	TC	$522.24	$714.00	$889.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $800.04 / $1,083.20 / $1,346.82	Professional		$800.04	$1,083.20	$1,346.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.17 / $158.12 / $224.67	Professional	26	$109.17	$158.12	$224.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $505.10 / $872.53 / $1,213.14	Professional	TC	$505.10	$872.53	$1,213.14
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,088.88 / $1,088.88 / $1,088.88	Facility	26	$1,088.88	$1,088.88	$1,088.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $853.02 / $1,101.93 / $1,282.92	Professional		$853.02	$1,101.93	$1,282.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $146.63 / $190.24 / $232.14	Professional	26	$146.63	$190.24	$232.14
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $698.67 / $900.91 / $1,050.78	Professional	TC	$698.67	$900.91	$1,050.78
United Facility/Professional Professional Modifier Low / Median / High Price $634.05 / $656.76 / $1,441.79	Professional		$634.05	$656.76	$1,441.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $101.06 / $106.47 / $260.64	Professional	26	$101.06	$106.47	$260.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $528.71 / $568.19 / $1,200.13	Professional	TC	$528.71	$568.19	$1,200.13