Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $207.71 / $242.53 / $492.87	Facility	26	$207.71	$242.53	$492.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $642.41 / $1,350.21 / $3,018.14	Professional		$642.41	$1,350.21	$3,018.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $573.24 / $1,225.65 / $2,609.08	Professional	TC	$573.24	$1,225.65	$2,609.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,130.71 / $1,964.78 / $2,787.88	Professional		$1,130.71	$1,964.78	$2,787.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $986.57 / $1,737.81 / $2,493.85	Professional	TC	$986.57	$1,737.81	$2,493.85
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,908.18 / $2,215.78 / $2,584.66	Professional		$1,908.18	$2,215.78	$2,584.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $185.02 / $225.03 / $250.62	Professional	26	$185.02	$225.03	$250.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,723.15 / $1,987.70 / $2,334.04	Professional	TC	$1,723.15	$1,987.70	$2,334.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,014.50 / $1,596.30 / $2,929.89	Professional		$1,014.50	$1,596.30	$2,929.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $740.52 / $1,714.76 / $2,675.76	Professional	TC	$740.52	$1,714.76	$2,675.76
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $161.21 / $191.01 / $202.64	Facility	26	$161.21	$191.01	$202.64
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $486.90 / $486.90 / $718.20	Professional		$486.90	$486.90	$718.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $833.17 / $1,169.09 / $1,616.71	Professional	TC	$833.17	$1,169.09	$1,616.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,235.68 / $2,133.13 / $2,749.95	Professional		$1,235.68	$2,133.13	$2,749.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,034.26 / $1,732.13 / $2,387.15	Professional	TC	$1,034.26	$1,732.13	$2,387.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,406.69 / $2,406.69 / $2,406.69	Facility	26	$2,406.69	$2,406.69	$2,406.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,724.88 / $2,201.38 / $2,730.70	Professional		$1,724.88	$2,201.38	$2,730.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,546.52 / $1,969.20 / $2,448.34	Professional	TC	$1,546.52	$1,969.20	$2,448.34
United Facility/Professional Professional Modifier Low / Median / High Price $903.19 / $1,082.69 / $3,066.16	Professional		$903.19	$1,082.69	$3,066.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $817.30 / $1,013.00 / $2,749.13	Professional	TC	$817.30	$1,013.00	$2,749.13