Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $109.65 / $120.23	Facility	26	$66.07	$109.65	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $354.81 / $776.25	Professional		$269.15	$354.81	$776.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $208.93	Professional	26	$43.65	$53.70	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $288.40 / $630.96	Professional	TC	$223.87	$288.40	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $812.83 / $1,000.00	Professional		$537.03	$812.83	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $138.04	Professional	26	$77.62	$114.82	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $707.95 / $870.96	Professional	TC	$457.09	$707.95	$870.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $660.69 / $776.25	Professional		$331.13	$660.69	$776.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $100.00 / $112.20	Professional	26	$47.86	$100.00	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $562.34 / $676.08	Professional	TC	$288.40	$562.34	$676.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $109.65 / $147.91	Facility	26	$66.07	$109.65	$147.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $616.60 / $977.24	Professional		$389.05	$616.60	$977.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $107.15 / $147.91	Professional	26	$56.23	$107.15	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $588.84 / $851.14	Professional	TC	$346.74	$588.84	$851.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $93.33 / $95.50	Facility	26	$77.62	$93.33	$95.50
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Professional		$223.87	$223.87	$223.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $85.11 / $104.71	Professional	26	$57.54	$85.11	$104.71
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $630.96	Professional	TC	$346.74	$501.19	$630.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $691.83 / $912.01	Professional		$478.63	$691.83	$912.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $95.50 / $134.90	Professional	26	$67.61	$95.50	$134.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $549.54 / $776.25	Professional	TC	$380.19	$549.54	$776.25
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 $602.56 / $691.83 / $812.83	Professional		$602.56	$691.83	$812.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $100.00 / $120.23	Professional	26	$87.10	$100.00	$120.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $602.56 / $691.83	Professional	TC	$524.81	$602.56	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $309.03 / $1,023.29	Professional		$302.00	$309.03	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $46.77 / $147.91	Professional	26	$43.65	$46.77	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $263.03 / $870.96	Professional	TC	$263.03	$263.03	$870.96