Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $102.33 / $112.20	Facility	26	$57.54	$102.33	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $363.08 / $707.95	Professional		$295.12	$363.08	$707.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $316.23 / $630.96	Professional	TC	$251.19	$316.23	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $724.44 / $1,071.52	Professional		$380.19	$724.44	$1,071.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $630.96 / $933.25	Professional	TC	$323.59	$630.96	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $891.25 / $1,047.13	Professional		$724.44	$891.25	$1,047.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $97.72 / $114.82	Professional	26	$81.28	$97.72	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $794.33 / $912.01	Professional	TC	$630.96	$794.33	$912.01
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	26	$74.13	$74.13	$74.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $724.44 / $1,000.00	Professional		$446.68	$724.44	$1,000.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $691.83 / $977.24	Professional	TC	$331.13	$691.83	$977.24
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $87.10 / $89.13	Facility	26	$72.44	$87.10	$89.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $537.03 / $645.65	Professional	TC	$380.19	$537.03	$645.65
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $50.12 / $72.44	Facility	26	$10.72	$50.12	$72.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $741.31 / $1,023.29	Professional		$537.03	$741.31	$1,023.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $616.60 / $933.25	Professional	TC	$371.54	$616.60	$933.25
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility	26	$1,513.56	$1,513.56	$1,513.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $724.44 / $1,023.29	Professional		$562.34	$724.44	$1,023.29
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $630.96 / $891.25	Professional	TC	$489.78	$630.96	$891.25
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $676.08 / $1,023.29	Professional		$371.54	$676.08	$1,023.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $588.84 / $891.25	Professional	TC	$316.23	$588.84	$891.25