Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $575.44 / $1,047.13	Professional		$467.74	$575.44	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $51.29 / $100.00	Professional	26	$43.65	$51.29	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $512.86 / $954.99	Professional	TC	$398.11	$512.86	$954.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $891.25	Professional		$331.13	$501.19	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $47.86 / $95.50	Professional	26	$30.20	$47.86	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $457.09 / $812.83	Professional	TC	$295.12	$457.09	$812.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $1,071.52 / $1,548.82	Professional		$537.03	$1,071.52	$1,548.82
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $109.65 / $154.88	Professional	26	$53.70	$109.65	$154.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $977.24 / $1,380.38	Professional	TC	$489.78	$977.24	$1,380.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $977.24 / $1,949.84	Professional		$645.65	$977.24	$1,949.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $97.72 / $186.21	Professional	26	$52.48	$97.72	$186.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $891.25 / $1,778.28	Professional	TC	$524.81	$891.25	$1,778.28
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $112.20 / $112.20	Facility	26	$93.33	$112.20	$112.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $114.82	Professional	26	$66.07	$85.11	$114.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $812.83 / $1,096.48	Professional	TC	$562.34	$812.83	$1,096.48
Providence Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $1,148.15 / $1,778.28	Professional		$478.63	$1,148.15	$1,778.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $58.88 / $165.96	Professional	26	$33.11	$58.88	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $575.44 / $1,479.11	Professional	TC	$316.23	$575.44	$1,479.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $1,230.27 / $1,862.09	Professional		$691.83	$1,230.27	$1,862.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $114.82 / $177.83	Professional	26	$67.61	$114.82	$177.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $1,122.02 / $1,659.59	Professional	TC	$630.96	$1,122.02	$1,659.59
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $588.84 / $1,862.09	Professional		$354.81	$588.84	$1,862.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $60.26 / $177.83	Professional	26	$35.48	$60.26	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $524.81 / $1,698.24	Professional	TC	$316.23	$524.81	$1,698.24