Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.72 / $45.43 / $99.79	Facility	26	$33.72	$45.43	$99.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $104.75 / $226.48	Professional		$73.73	$104.75	$226.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $22.92 / $50.69	Professional	26	$16.78	$22.92	$50.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $74.14 / $177.44	Professional	TC	$55.57	$74.14	$177.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.45 / $174.67 / $273.95	Professional		$87.45	$174.67	$273.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.48 / $39.40 / $57.68	Professional	26	$22.48	$39.40	$57.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.20 / $134.62 / $220.81	Professional	TC	$66.20	$134.62	$220.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.35 / $231.47 / $268.77	Professional		$194.35	$231.47	$268.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.38 / $45.98 / $51.77	Professional	26	$38.38	$45.98	$51.77
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $154.79 / $184.82 / $217.00	Professional	TC	$154.79	$184.82	$217.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $141.12 / $171.76 / $302.94	Professional		$141.12	$171.76	$302.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.03 / $42.58 / $63.66	Professional	26	$32.03	$42.58	$63.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.42 / $165.70 / $241.95	Professional	TC	$125.42	$165.70	$241.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.10 / $38.86 / $39.53	Facility	26	$28.10	$38.86	$39.53
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $58.23 / $78.25 / $104.84	Professional		$58.23	$78.25	$104.84
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.96 / $33.06 / $42.34	Professional	26	$25.96	$33.06	$42.34
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $85.02 / $130.35 / $158.79	Professional	TC	$85.02	$130.35	$158.79
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.66 / $212.40 / $281.20	Professional		$134.66	$212.40	$281.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.40 / $58.02	Professional	26	$26.92	$40.40	$58.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.82 / $154.80 / $222.61	Professional	TC	$95.82	$154.80	$222.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $139.60 / $205.05 / $271.12	Professional		$139.60	$205.05	$271.12
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $35.58 / $42.75 / $56.58	Professional	26	$35.58	$42.75	$56.58
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $108.57 / $162.35 / $216.53	Professional	TC	$108.57	$162.35	$216.53
United Facility/Professional Professional Modifier Low / Median / High Price $81.56 / $111.85 / $270.79	Professional		$81.56	$111.85	$270.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.78 / $26.49 / $60.88	Professional	26	$20.78	$26.49	$60.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.73 / $86.29 / $209.49	Professional	TC	$60.73	$86.29	$209.49