Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.76 / $118.13 / $127.04	Facility	26	$92.76	$118.13	$127.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $403.39 / $473.97 / $1,132.60	Professional		$403.39	$473.97	$1,132.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.13 / $68.29 / $144.68	Professional	26	$55.13	$68.29	$144.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $345.06 / $411.86 / $806.94	Professional	TC	$345.06	$411.86	$806.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.81 / $64.81 / $64.81	Facility	26	$64.81	$64.81	$64.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $515.54 / $913.49 / $1,225.23	Professional		$515.54	$913.49	$1,225.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.45 / $120.82 / $165.21	Professional	26	$80.45	$120.82	$165.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $443.98 / $792.00 / $1,077.51	Professional	TC	$443.98	$792.00	$1,077.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $793.31 / $1,034.35 / $1,204.02	Professional		$793.31	$1,034.35	$1,204.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $99.01 / $128.93 / $145.16	Professional	26	$99.01	$128.93	$145.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $694.30 / $901.98 / $1,058.85	Professional	TC	$694.30	$901.98	$1,058.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $638.52 / $783.36 / $1,255.68	Professional		$638.52	$783.36	$1,255.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.66 / $116.62 / $178.24	Professional	26	$89.66	$116.62	$178.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $557.01 / $773.50 / $1,218.00	Professional	TC	$557.01	$773.50	$1,218.00
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $82.32 / $111.19 / $118.32	Facility	26	$82.32	$111.19	$118.32
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.54 / $102.48 / $148.80	Professional	26	$67.54	$102.48	$148.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $411.00 / $577.41 / $779.83	Professional	TC	$411.00	$577.41	$779.83
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.81 / $64.81 / $64.81	Facility	26	$64.81	$64.81	$64.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $564.04 / $886.97 / $1,154.51	Professional		$564.04	$886.97	$1,154.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $80.00 / $126.27 / $172.85	Professional	26	$80.00	$126.27	$172.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $443.98 / $823.20 / $1,077.51	Professional	TC	$443.98	$823.20	$1,077.51
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,043.22 / $3,043.22 / $3,043.22	Facility	26	$3,043.22	$3,043.22	$3,043.22
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $674.46 / $832.46 / $1,183.43	Professional		$674.46	$832.46	$1,183.43
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $90.18 / $111.31 / $158.22	Professional	26	$90.18	$111.31	$158.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $584.28 / $721.15 / $1,025.20	Professional	TC	$584.28	$721.15	$1,025.20
United Facility/Professional Professional Modifier Low / Median / High Price $632.34 / $887.53 / $1,328.81	Professional		$632.34	$887.53	$1,328.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.72 / $126.25 / $177.67	Professional	26	$90.72	$126.25	$177.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $541.62 / $752.64 / $1,120.95	Professional	TC	$541.62	$752.64	$1,120.95