Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.45 / $94.64 / $193.64	Facility	26	$71.45	$94.64	$193.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $411.83 / $625.86 / $2,043.00	Professional		$411.83	$625.86	$2,043.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.71 / $58.09 / $225.00	Professional	26	$36.71	$58.09	$225.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $375.12 / $448.71 / $1,031.84	Professional	TC	$375.12	$448.71	$1,031.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $722.05 / $973.15 / $1,284.27	Professional		$722.05	$973.15	$1,284.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.86 / $94.88 / $122.30	Professional	26	$68.86	$94.88	$122.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $654.80 / $878.27 / $1,161.97	Professional	TC	$654.80	$878.27	$1,161.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $412.76 / $919.37 / $984.61	Professional		$412.76	$919.37	$984.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $41.44 / $95.56 / $98.85	Professional	26	$41.44	$95.56	$98.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $371.32 / $821.08 / $885.75	Professional	TC	$371.32	$821.08	$885.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $660.50 / $720.72 / $1,239.22	Professional		$660.50	$720.72	$1,239.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $95.01 / $132.61	Professional	26	$66.70	$95.01	$132.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $556.66 / $792.82 / $1,112.19	Professional	TC	$556.66	$792.82	$1,112.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.53 / $82.50 / $85.09	Facility	26	$61.53	$82.50	$85.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.34 / $75.38 / $92.71	Professional	26	$53.34	$75.38	$92.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $498.12 / $668.22 / $857.95	Professional	TC	$498.12	$668.22	$857.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $664.09 / $988.72 / $1,158.18	Professional		$664.09	$988.72	$1,158.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.23 / $86.21 / $122.30	Professional	26	$67.23	$86.21	$122.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $648.61 / $839.58 / $1,161.97	Professional	TC	$648.61	$839.58	$1,161.97
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,526.97 / $1,526.97 / $1,526.97	Facility	26	$1,526.97	$1,526.97	$1,526.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $767.97 / $979.68 / $1,155.00	Professional		$767.97	$979.68	$1,155.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $78.75 / $99.75 / $118.44	Professional	26	$78.75	$99.75	$118.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $689.22 / $877.94 / $1,036.57	Professional	TC	$689.22	$877.94	$1,036.57
United Facility/Professional Professional Modifier Low / Median / High Price $388.67 / $476.94 / $1,297.42	Professional		$388.67	$476.94	$1,297.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.49 / $47.40 / $131.26	Professional	26	$38.49	$47.40	$131.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $349.71 / $360.64 / $1,163.89	Professional	TC	$349.71	$360.64	$1,163.89