Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $131.83 / $141.25	Facility	26	$72.44	$131.83	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $407.38 / $794.33	Professional		$316.23	$407.38	$794.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $346.74 / $691.83	Professional	TC	$263.03	$346.74	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $776.25 / $1,174.90	Professional		$407.38	$776.25	$1,174.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $691.83 / $1,023.29	Professional	TC	$316.23	$691.83	$1,023.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,000.00 / $1,148.15	Professional		$794.33	$1,000.00	$1,148.15
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $123.03 / $144.54	Professional	26	$102.33	$123.03	$144.54
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $891.25 / $1,023.29	Professional	TC	$707.95	$891.25	$1,023.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $758.58 / $1,096.48	Professional		$380.19	$758.58	$1,096.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $707.95 / $977.24	Professional	TC	$275.42	$707.95	$977.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $112.20	Facility	26	$91.20	$109.65	$112.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $436.52 / $691.83	Professional	TC	$331.13	$436.52	$691.83
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $812.83 / $1,148.15	Professional		$489.78	$812.83	$1,148.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $645.65 / $1,023.29	Professional	TC	$363.08	$645.65	$1,023.29
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $831.76 / $831.76 / $831.76	Facility	26	$831.76	$831.76	$831.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $812.83 / $1,122.02	Professional		$616.60	$812.83	$1,122.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $707.95 / $977.24	Professional	TC	$524.81	$707.95	$977.24
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $758.58 / $1,148.15	Professional		$323.59	$758.58	$1,148.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $645.65 / $977.24	Professional	TC	$275.42	$645.65	$977.24