Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $89.13 / $109.65	Facility	26	$54.95	$89.13	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $1,230.27	Professional		$223.87	$309.03	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $123.03	Professional	26	$37.15	$54.95	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $251.19 / $562.34	Professional	TC	$186.21	$251.19	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $691.83 / $794.33	Professional		$457.09	$691.83	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $95.50 / $114.82	Professional	26	$64.57	$95.50	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $602.56 / $676.08	Professional	TC	$389.05	$602.56	$676.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $562.34 / $660.69	Professional		$281.84	$562.34	$660.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $85.11 / $93.33	Professional	26	$39.81	$85.11	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $478.63 / $575.44	Professional	TC	$245.47	$478.63	$575.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $81.28 / $109.65	Facility	26	$54.95	$81.28	$109.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $831.76	Professional		$281.84	$478.63	$831.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $89.13 / $125.89	Professional	26	$42.66	$89.13	$125.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $512.86 / $724.44	Professional	TC	$239.88	$512.86	$724.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $77.62 / $81.28	Facility	26	$64.57	$77.62	$81.28
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $398.11	Professional		$275.42	$398.11	$398.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $72.44 / $89.13	Professional	26	$48.98	$72.44	$89.13
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $363.08 / $512.86	Professional	TC	$269.15	$363.08	$512.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $758.58	Professional		$398.11	$562.34	$758.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $114.82	Professional	26	$57.54	$81.28	$114.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $457.09 / $660.69	Professional	TC	$316.23	$457.09	$660.69
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 $467.74 / $602.56 / $691.83	Professional		$467.74	$602.56	$691.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $83.18 / $102.33	Professional	26	$72.44	$83.18	$102.33
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $512.86 / $588.84	Professional	TC	$398.11	$512.86	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $263.03 / $891.25	Professional		$223.87	$263.03	$891.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $39.81 / $123.03	Professional	26	$36.31	$39.81	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $229.09 / $758.58	Professional	TC	$186.21	$229.09	$758.58