Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $213.80 / $245.47	Facility	26	$154.88	$213.80	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,023.29 / $2,041.74	Professional		$758.58	$1,023.29	$2,041.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $109.65 / $257.04	Professional	26	$81.28	$109.65	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $933.25 / $1,778.28	Professional	TC	$676.08	$933.25	$1,778.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,230.27 / $2,511.89	Professional		$851.14	$1,230.27	$2,511.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $141.25 / $281.84	Professional	26	$95.50	$141.25	$281.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $1,096.48 / $2,238.72	Professional	TC	$758.58	$1,096.48	$2,238.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,698.24 / $2,041.74	Professional		$870.96	$1,698.24	$2,041.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $204.17 / $229.09	Professional	26	$95.50	$204.17	$229.09
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $1,513.56 / $1,778.28	Professional	TC	$776.25	$1,513.56	$1,778.28
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $245.47 / $245.47	Facility	26	$165.96	$245.47	$245.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,862.09 / $2,818.38	Professional		$1,318.26	$1,862.09	$2,818.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $218.78 / $316.23	Professional	26	$141.25	$218.78	$316.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,148.15 / $1,621.81 / $2,344.23	Professional	TC	$1,148.15	$1,621.81	$2,344.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $190.55 / $194.98	Facility	26	$154.88	$190.55	$194.98
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Professional		$812.83	$812.83	$812.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $154.88 / $190.55	Professional	26	$125.89	$154.88	$190.55
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,380.38 / $1,445.44	Professional	TC	$1,174.90	$1,380.38	$1,445.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,819.70 / $2,398.83	Professional		$851.14	$1,819.70	$2,398.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $177.83 / $275.42	Professional	26	$95.50	$177.83	$275.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $1,445.44 / $2,089.30	Professional	TC	$758.58	$1,445.44	$2,089.30
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,897.79 / $4,897.79 / $4,897.79	Facility	26	$4,897.79	$4,897.79	$4,897.79
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,862.09 / $2,137.96	Professional		$1,584.89	$1,862.09	$2,137.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $204.17 / $245.47	Professional	26	$177.83	$204.17	$245.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,412.54 / $1,659.59 / $1,862.09	Professional	TC	$1,412.54	$1,659.59	$1,862.09
United Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $933.25 / $2,691.53	Professional		$812.83	$933.25	$2,691.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $104.71 / $295.12	Professional	26	$89.13	$104.71	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $812.83 / $2,398.83	Professional	TC	$724.44	$812.83	$2,398.83