Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $606.54 / $606.54 / $606.54	Facility	TC	$606.54	$606.54	$606.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $278.18 / $469.48 / $607.79	Professional		$278.18	$469.48	$607.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.27 / $159.71 / $233.47	Professional	26	$122.27	$159.71	$233.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.61 / $217.32 / $402.77	Professional	TC	$148.61	$217.32	$402.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $304.88 / $304.88 / $304.88	Facility		$304.88	$304.88	$304.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $326.16 / $326.16 / $326.16	Professional		$326.16	$326.16	$326.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $153.56 / $153.56 / $153.56	Professional	26	$153.56	$153.56	$153.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $172.60 / $172.60 / $172.60	Professional	TC	$172.60	$172.60	$172.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $350.19 / $725.36 / $1,033.90	Professional		$350.19	$725.36	$1,033.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $165.65 / $343.11 / $489.07	Professional	26	$165.65	$343.11	$489.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $184.54 / $382.24 / $544.84	Professional	TC	$184.54	$382.24	$544.84
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $217.25 / $469.48 / $1,464.21	Facility		$217.25	$469.48	$1,464.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $584.96 / $822.00 / $1,162.83	Professional		$584.96	$822.00	$1,162.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $248.70 / $302.11 / $547.46	Professional	26	$248.70	$302.11	$547.46
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.54 / $339.57 / $615.36	Professional	TC	$279.54	$339.57	$615.36
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $549.94 / $725.35 / $1,181.70	Facility		$549.94	$725.35	$1,181.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $216.09 / $343.11 / $347.73	Facility	26	$216.09	$343.11	$347.73
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $301.50 / $382.24 / $568.83	Facility	TC	$301.50	$382.24	$568.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $184.74 / $296.18 / $344.38	Professional	26	$184.74	$296.18	$344.38
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $250.65 / $445.63 / $814.05	Professional	TC	$250.65	$445.63	$814.05
Providence Facility/Professional Facility Modifier Low / Median / High Price $311.00 / $845.27 / $1,056.33	Facility		$311.00	$845.27	$1,056.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $326.16 / $707.07 / $1,064.49	Professional		$326.16	$707.07	$1,064.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $153.56 / $153.56 / $232.39	Professional	26	$153.56	$153.56	$232.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $172.60 / $172.60 / $255.76	Professional	TC	$172.60	$172.60	$255.76
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,191.76 / $1,191.76 / $1,198.55	Facility		$1,191.76	$1,191.76	$1,198.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $580.49 / $705.00 / $1,142.54	Professional		$580.49	$705.00	$1,142.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $279.41 / $349.10 / $549.95	Professional	26	$279.41	$349.10	$549.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $301.07 / $355.90 / $603.17	Professional	TC	$301.07	$355.90	$603.17
United Facility/Professional Professional Modifier Low / Median / High Price $208.74 / $347.90 / $1,129.89	Professional		$208.74	$347.90	$1,129.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.74 / $111.30 / $543.87	Professional	26	$109.74	$111.30	$543.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.44 / $197.83 / $615.20	Professional	TC	$97.44	$197.83	$615.20