Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $144.54 / $239.88	Facility	26	$102.33	$144.54	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $478.63 / $870.96	Professional		$251.19	$478.63	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $125.89 / $199.53	Professional	26	$66.07	$125.89	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $338.84 / $512.86	Professional	TC	$181.97	$338.84	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $478.63 / $954.99	Professional		$239.88	$478.63	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $93.33 / $194.98	Professional	26	$58.88	$93.33	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $371.54 / $851.14	Professional	TC	$177.83	$371.54	$851.14
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $501.19 / $616.60	Professional		$436.52	$501.19	$616.60
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $134.90 / $162.18	Professional	26	$117.49	$134.90	$162.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $371.54 / $457.09	Professional	TC	$316.23	$371.54	$457.09
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $239.88 / $239.88	Facility	26	$128.82	$239.88	$239.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $524.81 / $851.14	Professional		$380.19	$524.81	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $128.82 / $190.55	Professional	26	$102.33	$128.82	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $380.19 / $724.44	Professional	TC	$275.42	$380.19	$724.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $125.89 / $128.82	Facility	26	$104.71	$125.89	$128.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Professional		$251.19	$251.19	$251.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $117.49 / $141.25	Professional	26	$77.62	$117.49	$141.25
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $436.52 / $776.25	Professional	TC	$302.00	$436.52	$776.25
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $102.33	Facility	26	$15.49	$72.44	$102.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $575.44 / $870.96	Professional		$257.04	$575.44	$870.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $128.82 / $186.21	Professional	26	$63.10	$128.82	$186.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $457.09 / $831.76	Professional	TC	$177.83	$457.09	$831.76
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $549.54 / $741.31	Professional		$426.58	$549.54	$741.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $134.90 / $173.78	Professional	26	$114.82	$134.90	$173.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $407.38 / $602.56	Professional	TC	$309.03	$407.38	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $446.68 / $794.33	Professional		$223.87	$446.68	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $181.97	Professional	26	$57.54	$77.62	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $354.81 / $588.84	Professional	TC	$165.96	$354.81	$588.84