Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $58.88 / $64.57	Facility	26	$37.15	$58.88	$64.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $269.15 / $1,071.52	Professional		$199.53	$269.15	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $27.54 / $58.88	Professional	26	$20.42	$27.54	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $245.47 / $478.63	Professional	TC	$181.97	$245.47	$478.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $562.34 / $691.83	Professional		$371.54	$562.34	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $67.61	Professional	26	$38.02	$54.95	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $512.86 / $630.96	Professional	TC	$331.13	$512.86	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $457.09 / $537.03	Professional		$234.42	$457.09	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $48.98 / $54.95	Professional	26	$23.44	$48.98	$54.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $407.38 / $489.78	Professional	TC	$208.93	$407.38	$489.78
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $58.88 / $95.50	Facility	26	$39.81	$58.88	$95.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $489.78 / $676.08	Professional		$269.15	$489.78	$676.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $53.70 / $72.44	Professional	26	$25.70	$53.70	$72.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $446.68 / $602.56	Professional	TC	$234.42	$446.68	$602.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $45.71 / $47.86	Facility	26	$37.15	$45.71	$47.86
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Professional		$371.54	$371.54	$371.54
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $39.81 / $48.98	Professional	26	$28.18	$39.81	$48.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $338.84 / $436.52	Professional	TC	$245.47	$338.84	$436.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $489.78 / $630.96	Professional		$338.84	$489.78	$630.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $47.86 / $66.07	Professional	26	$33.11	$47.86	$66.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $426.58 / $562.34	Professional	TC	$295.12	$426.58	$562.34
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Facility	26	$1,174.90	$1,174.90	$1,174.90
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $478.63 / $562.34	Professional		$416.87	$478.63	$562.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $48.98 / $58.88	Professional	26	$42.66	$48.98	$58.88
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $436.52 / $501.19	Professional	TC	$380.19	$436.52	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $251.19 / $707.95	Professional		$208.93	$251.19	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $25.12 / $70.79	Professional	26	$21.38	$25.12	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $223.87 / $630.96	Professional	TC	$190.55	$223.87	$630.96