Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $363.08 / $630.96 / $707.95	Facility	26	$363.08	$630.96	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,348.96 / $2,290.87	Professional		$1,023.29	$1,348.96	$2,290.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $407.38 / $1,258.93	Professional	26	$288.40	$407.38	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $933.25 / $1,659.59	Professional	TC	$724.44	$933.25	$1,659.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $2,344.23 / $3,019.95	Professional		$1,318.26	$2,344.23	$3,019.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $660.69 / $851.14	Professional	26	$389.05	$660.69	$851.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $933.25 / $1,698.24 / $2,290.87	Professional	TC	$933.25	$1,698.24	$2,290.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $2,187.76 / $2,691.53	Professional		$1,096.48	$2,187.76	$2,691.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $602.56 / $724.44	Professional	26	$288.40	$602.56	$724.44
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $1,548.82 / $1,995.26	Professional	TC	$794.33	$1,548.82	$1,995.26
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $467.74 / $645.65	Facility	26	$446.68	$467.74	$645.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,041.74 / $3,162.28	Professional		$1,348.96	$2,041.74	$3,162.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $602.56 / $933.25	Professional	26	$295.12	$602.56	$933.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $1,584.89 / $2,238.72	Professional	TC	$870.96	$1,584.89	$2,238.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $549.54 / $588.84	Facility	26	$467.74	$549.54	$588.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $524.81 / $645.65	Professional	26	$363.08	$524.81	$645.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $851.14 / $1,258.93 / $1,584.89	Professional	TC	$851.14	$1,258.93	$1,584.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,290.87 / $3,019.95	Professional		$1,513.56	$2,290.87	$3,019.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $602.56 / $831.76	Professional	26	$407.38	$602.56	$831.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,621.81 / $2,187.76	Professional	TC	$1,000.00	$1,621.81	$2,187.76
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $9,549.93 / $9,549.93 / $9,549.93	Facility	26	$9,549.93	$9,549.93	$9,549.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,398.83 / $3,235.94	Professional		$1,949.84	$2,398.83	$3,235.94
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $676.08 / $891.25	Professional	26	$537.03	$676.08	$891.25
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $1,445.44 / $1,737.80 / $2,344.23	Professional	TC	$1,445.44	$1,737.80	$2,344.23
United Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,137.96 / $3,019.95	Professional		$1,513.56	$2,137.96	$3,019.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $630.96 / $851.14	Professional	26	$446.68	$630.96	$851.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,071.52 / $1,513.56 / $2,187.76	Professional	TC	$1,071.52	$1,513.56	$2,187.76