Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $281.84 / $478.63	Facility	26	$162.18	$281.84	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $812.83 / $1,621.81	Professional		$602.56	$812.83	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $162.18 / $389.05	Professional	26	$117.49	$162.18	$389.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $257.04 / $257.04	Professional	52	$199.53	$257.04	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $660.69 / $1,258.93	Professional	TC	$478.63	$660.69	$1,258.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,348.96 / $1,862.09	Professional		$707.95	$1,348.96	$1,862.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $234.42 / $363.08	Professional	26	$138.04	$234.42	$363.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $1,122.02 / $1,513.56	Professional	TC	$588.84	$1,122.02	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,584.89 / $1,819.70	Professional		$1,258.93	$1,584.89	$1,819.70
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $269.15 / $316.23	Professional	26	$218.78	$269.15	$316.23
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $1,047.13 / $1,318.26 / $1,513.56	Professional	TC	$1,047.13	$1,318.26	$1,513.56
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $257.04 / $331.13	Facility	26	$199.53	$257.04	$331.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,318.26 / $1,737.80	Professional		$794.33	$1,318.26	$1,737.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $269.15 / $363.08	Professional	26	$138.04	$269.15	$363.08
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $257.04 / $257.04	Professional	52	$199.53	$257.04	$257.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $1,148.15 / $1,479.11	Professional	TC	$588.84	$1,148.15	$1,479.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $239.88 / $245.47	Facility	26	$199.53	$239.88	$245.47
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $204.17 / $275.42	Professional	26	$144.54	$204.17	$275.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $870.96 / $1,202.26	Professional	TC	$602.56	$870.96	$1,202.26
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,348.96 / $1,778.28	Professional		$954.99	$1,348.96	$1,778.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $245.47 / $354.81	Professional	26	$162.18	$245.47	$354.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,071.52 / $1,513.56	Professional	TC	$691.83	$1,071.52	$1,513.56
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility	26	$3,019.95	$3,019.95	$3,019.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,258.93 / $1,778.28	Professional		$977.24	$1,258.93	$1,778.28
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $245.47 / $338.84	Professional	26	$177.83	$245.47	$338.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $1,023.29 / $1,445.44	Professional	TC	$794.33	$1,023.29	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,258.93 / $1,862.09	Professional		$831.76	$1,258.93	$1,862.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $251.19 / $363.08	Professional	26	$158.49	$251.19	$363.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $1,000.00 / $1,479.11	Professional	TC	$660.69	$1,000.00	$1,479.11