Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.56 / $101.56 / $113.45	Facility	26	$101.56	$101.56	$113.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $258.27 / $574.45	Professional		$206.63	$258.27	$574.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.00 / $53.60 / $137.19	Professional	26	$44.00	$53.60	$137.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $232.77 / $481.16	Professional	TC	$162.49	$232.77	$481.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $326.44 / $585.37 / $856.37	Professional		$326.44	$585.37	$856.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.97 / $93.99 / $137.87	Professional	26	$53.97	$93.99	$137.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $274.08 / $497.87 / $718.25	Professional	TC	$274.08	$497.87	$718.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $491.46 / $572.74 / $702.16	Professional		$491.46	$572.74	$702.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $84.89 / $100.00 / $115.92	Professional	26	$84.89	$100.00	$115.92
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $405.66 / $474.69 / $586.24	Professional	TC	$405.66	$474.69	$586.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $409.89 / $532.22 / $814.82	Professional		$409.89	$532.22	$814.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.51 / $87.55 / $142.16	Professional	26	$71.51	$87.55	$142.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $338.38 / $447.07 / $672.66	Professional	TC	$338.38	$447.07	$672.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.15 / $88.45 / $91.79	Facility	26	$66.15	$88.45	$91.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $61.10 / $80.40 / $100.65	Professional	26	$61.10	$80.40	$100.65
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $303.44 / $433.49 / $558.08	Professional	TC	$303.44	$433.49	$558.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $485.10 / $623.74 / $804.71	Professional		$485.10	$623.74	$804.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.49 / $98.21 / $129.02	Professional	26	$60.49	$98.21	$129.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $305.32 / $512.10 / $675.58	Professional	TC	$305.32	$512.10	$675.58
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 $512.24 / $654.55 / $766.53	Professional		$512.24	$654.55	$766.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.64 / $106.15 / $126.97	Professional	26	$83.64	$106.15	$126.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $427.40 / $546.14 / $639.55	Professional	TC	$427.40	$546.14	$639.55
United Facility/Professional Professional Modifier Low / Median / High Price $300.30 / $537.54 / $830.37	Professional		$300.30	$537.54	$830.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.60 / $91.80 / $139.32	Professional	26	$52.60	$91.80	$139.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $284.68 / $450.16 / $684.79	Professional	TC	$284.68	$450.16	$684.79