Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.21 / $151.91 / $333.68	Facility	26	$115.21	$151.91	$333.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $311.14 / $580.78 / $2,053.00	Professional		$311.14	$580.78	$2,053.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.43 / $93.67 / $261.00	Professional	26	$45.43	$93.67	$261.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $265.70 / $508.02 / $1,019.93	Professional	TC	$265.70	$508.02	$1,019.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $486.21 / $965.39 / $1,283.31	Professional		$486.21	$965.39	$1,283.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.16 / $135.52 / $194.71	Professional	26	$69.16	$135.52	$194.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $417.05 / $829.87 / $1,088.59	Professional	TC	$417.05	$829.87	$1,088.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $449.22 / $1,002.49 / $1,071.58	Professional		$449.22	$1,002.49	$1,071.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $65.98 / $152.16 / $157.41	Professional	26	$65.98	$152.16	$157.41
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $383.23 / $847.37 / $914.16	Professional	TC	$383.23	$847.37	$914.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $680.49 / $843.94 / $1,352.74	Professional		$680.49	$843.94	$1,352.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.21 / $151.27 / $211.13	Professional	26	$106.21	$151.27	$211.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $574.28 / $817.92 / $1,157.94	Professional	TC	$574.28	$817.92	$1,157.94
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.12 / $131.71 / $136.68	Facility	26	$87.12	$131.71	$136.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $712.20 / $712.20 / $752.05	Professional		$712.20	$712.20	$752.05
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $80.80 / $108.90 / $134.80	Professional	26	$80.80	$108.90	$134.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $591.74 / $709.68 / $806.01	Professional	TC	$591.74	$709.68	$806.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $668.17 / $1,071.20 / $1,251.04	Professional		$668.17	$1,071.20	$1,251.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.54 / $133.28 / $194.71	Professional	26	$74.54	$133.28	$194.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $456.47 / $816.19 / $1,088.59	Professional	TC	$456.47	$816.19	$1,088.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,287.53 / $4,287.53 / $4,287.53	Facility	26	$4,287.53	$4,287.53	$4,287.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $843.57 / $1,070.75 / $1,268.70	Professional		$843.57	$1,070.75	$1,268.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $126.00 / $162.46 / $189.50	Professional	26	$126.00	$162.46	$189.50
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $717.57 / $908.29 / $1,079.20	Professional	TC	$717.57	$908.29	$1,079.20
United Facility/Professional Professional Modifier Low / Median / High Price $429.74 / $491.28 / $1,440.76	Professional		$429.74	$491.28	$1,440.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $100.51 / $210.85	Professional	26	$62.31	$100.51	$210.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $367.43 / $965.07 / $1,264.30	Professional	TC	$367.43	$965.07	$1,264.30