Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $162.18 / $208.93	Facility	26	$104.71	$162.18	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $575.44 / $2,344.23	Professional		$426.58	$575.44	$2,344.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $263.03	Professional	26	$69.18	$95.50	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $457.09 / $870.96	Professional	TC	$331.13	$457.09	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,122.02 / $1,412.54	Professional		$724.44	$1,122.02	$1,412.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $181.97 / $218.78	Professional	26	$123.03	$181.97	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $933.25 / $1,202.26	Professional	TC	$602.56	$933.25	$1,202.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $933.25 / $1,071.52	Professional		$467.74	$933.25	$1,071.52
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $158.49 / $181.97	Professional	26	$77.62	$158.49	$181.97
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $758.58 / $912.01	Professional	TC	$389.05	$758.58	$912.01
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $151.36 / $257.04	Facility	26	$104.71	$151.36	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $870.96 / $1,348.96	Professional		$489.78	$870.96	$1,348.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $165.96 / $234.42	Professional	26	$74.13	$165.96	$234.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $812.83 / $1,122.02	Professional	TC	$416.87	$812.83	$1,122.02
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $147.91 / $151.36	Facility	26	$123.03	$147.91	$151.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $933.25 / $1,258.93	Professional		$851.14	$933.25	$1,258.93
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $134.90 / $162.18	Professional	26	$89.13	$134.90	$162.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $676.08 / $831.76	Professional	TC	$457.09	$676.08	$831.76
Providence Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $933.25 / $1,258.93	Professional		$645.65	$933.25	$1,258.93
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $151.36 / $213.80	Professional	26	$107.15	$151.36	$213.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $741.31 / $1,023.29	Professional	TC	$524.81	$741.31	$1,023.29
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Facility	26	$4,073.80	$4,073.80	$4,073.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $954.99 / $1,122.02	Professional		$831.76	$954.99	$1,122.02
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $158.49 / $190.55	Professional	26	$138.04	$158.49	$190.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $794.33 / $933.25	Professional	TC	$691.83	$794.33	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $524.81 / $1,380.38	Professional		$407.38	$524.81	$1,380.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $229.09	Professional	26	$69.18	$89.13	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $426.58 / $1,148.15	Professional	TC	$346.74	$426.58	$1,148.15