Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.44 / $163.31 / $377.14	Facility	26	$104.44	$163.31	$377.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $433.43 / $592.63 / $2,562.00	Professional		$433.43	$592.63	$2,562.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.88 / $94.57 / $305.00	Professional	26	$69.88	$94.57	$305.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $365.81 / $448.84 / $1,111.54	Professional	TC	$365.81	$448.84	$1,111.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $770.30 / $1,043.04 / $1,353.95	Professional		$770.30	$1,043.04	$1,353.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.20 / $170.40 / $218.73	Professional	26	$122.20	$170.40	$218.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $644.45 / $872.64 / $1,137.64	Professional	TC	$644.45	$872.64	$1,137.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $444.65 / $993.09 / $1,060.68	Professional		$444.65	$993.09	$1,060.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $74.18 / $171.06 / $176.95	Professional	26	$74.18	$171.06	$176.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $370.47 / $819.23 / $883.73	Professional	TC	$370.47	$819.23	$883.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $674.62 / $752.76 / $1,341.06	Professional		$674.62	$752.76	$1,341.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.01 / $169.51 / $236.59	Professional	26	$119.01	$169.51	$236.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $555.60 / $791.32 / $1,104.47	Professional	TC	$555.60	$791.32	$1,104.47
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $108.53 / $147.69 / $150.08	Facility	26	$108.53	$147.69	$150.08
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $854.96 / $854.96 / $857.90	Professional		$854.96	$854.96	$857.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $103.05 / $141.94 / $177.29	Professional	26	$103.05	$141.94	$177.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $529.65 / $682.66 / $874.59	Professional	TC	$529.65	$682.66	$874.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $664.65 / $1,043.04 / $1,224.58	Professional		$664.65	$1,043.04	$1,224.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $119.33 / $153.00 / $218.73	Professional	26	$119.33	$153.00	$218.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $641.44 / $822.44 / $1,137.64	Professional	TC	$641.44	$822.44	$1,137.64
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,053.27 / $4,053.27 / $4,053.27	Facility	26	$4,053.27	$4,053.27	$4,053.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $825.93 / $1,065.83 / $1,242.17	Professional		$825.93	$1,065.83	$1,242.17
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $137.25 / $175.93 / $212.24	Professional	26	$137.25	$175.93	$212.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $684.81 / $882.86 / $1,029.93	Professional	TC	$684.81	$882.86	$1,029.93
United Facility/Professional Professional Modifier Low / Median / High Price $411.98 / $607.82 / $1,394.77	Professional		$411.98	$607.82	$1,394.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.42 / $83.87 / $238.32	Professional	26	$68.42	$83.87	$238.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $343.26 / $429.80 / $1,156.45	Professional	TC	$343.26	$429.80	$1,156.45