Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $175.32 / $448.23 / $666.80	Facility		$175.32	$448.23	$666.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.34 / $53.00 / $133.19	Facility	26	$37.34	$53.00	$133.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.34 / $163.92 / $479.00	Professional		$107.34	$163.92	$479.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $39.36 / $142.00	Professional	26	$24.07	$39.36	$142.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.00 / $64.05 / $177.57	Professional	52	$43.00	$64.05	$177.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $103.70 / $262.08	Professional	TC	$83.28	$103.70	$262.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $93.06 / $301.52 / $367.38	Facility		$93.06	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.17 / $237.92 / $325.50	Professional		$120.17	$237.92	$325.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.37 / $55.67 / $77.76	Professional	26	$30.37	$55.67	$77.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.84 / $185.25 / $248.34	Professional	TC	$96.84	$185.25	$248.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $209.61 / $244.28 / $297.83	Professional		$209.61	$244.28	$297.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $50.40 / $59.58 / $68.83	Professional	26	$50.40	$59.58	$68.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $185.44 / $229.02	Professional	TC	$158.49	$185.44	$229.02
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $110.99 / $199.94 / $322.52	Facility		$110.99	$199.94	$322.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $175.07 / $190.98 / $340.56	Professional		$175.07	$190.98	$340.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $51.09 / $84.89	Professional	26	$42.70	$51.09	$84.89
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.36 / $162.97 / $263.12	Professional	TC	$132.36	$162.97	$263.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $139.78 / $216.06 / $232.56	Facility		$139.78	$216.06	$232.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.20 / $52.69 / $53.60	Facility	26	$39.20	$52.69	$53.60
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.15 / $47.56 / $59.20	Professional	26	$32.15	$47.56	$59.20
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $106.53 / $150.08 / $189.00	Professional	TC	$106.53	$150.08	$189.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $121.49 / $260.97 / $338.77	Facility		$121.49	$260.97	$338.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $198.66 / $244.94 / $325.50	Professional		$198.66	$244.94	$325.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $35.72 / $58.68 / $77.69	Professional	26	$35.72	$58.68	$77.69
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $130.49 / $130.49 / $130.49	Professional	52	$130.49	$130.49	$130.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $115.97 / $192.37 / $247.81	Professional	TC	$115.97	$192.37	$247.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $312.19 / $372.00 / $463.05	Facility		$312.19	$372.00	$463.05
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 $204.18 / $265.39 / $317.41	Professional		$204.18	$265.39	$317.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $64.81 / $76.75	Professional	26	$49.20	$64.81	$76.75
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $157.85 / $205.49 / $240.66	Professional	TC	$157.85	$205.49	$240.66
United Facility/Professional Facility Modifier Low / Median / High Price $143.63 / $143.63 / $143.63	Facility		$143.63	$143.63	$143.63
United Facility/Professional Professional Modifier Low / Median / High Price $117.86 / $141.41 / $347.05	Professional		$117.86	$141.41	$347.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.39 / $31.56 / $86.18	Professional	26	$28.39	$31.56	$86.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.14 / $100.66 / $270.22	Professional	TC	$89.14	$100.66	$270.22