Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $200.20 / $756.48 / $974.70	Facility		$200.20	$756.48	$974.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.03 / $39.43 / $65.53	Facility	26	$27.03	$39.43	$65.53
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $135.72 / $219.97 / $900.60	Facility	TC	$135.72	$219.97	$900.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $132.50 / $542.69	Professional		$26.52	$132.50	$542.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $29.47 / $97.57	Professional	26	$20.98	$29.47	$97.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.53 / $122.57 / $271.67	Professional	TC	$95.53	$122.57	$271.67
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.95 / $301.52 / $367.38	Facility		$107.95	$301.52	$367.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.76 / $258.39 / $388.80	Professional		$153.76	$258.39	$388.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.34 / $44.23 / $64.89	Professional	26	$25.34	$44.23	$64.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.81 / $217.88 / $331.36	Professional	TC	$129.81	$217.88	$331.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $226.17 / $263.57 / $322.77	Professional		$226.17	$263.57	$322.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.81 / $45.99 / $52.99	Professional	26	$38.81	$45.99	$52.99
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $186.70 / $218.44 / $269.77	Professional	TC	$186.70	$218.44	$269.77
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $125.69 / $238.29 / $372.80	Facility		$125.69	$238.29	$372.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $188.94 / $231.31 / $363.96	Professional		$188.94	$231.31	$363.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $41.58 / $65.76	Professional	26	$33.08	$41.58	$65.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $155.84 / $205.90 / $309.80	Professional	TC	$155.84	$205.90	$309.80
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $166.00 / $229.16 / $254.18	Facility		$166.00	$229.16	$254.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $31.36 / $40.69 / $42.84	Facility	26	$31.36	$40.69	$42.84
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $157.88 / $188.27 / $202.64	Facility	TC	$157.88	$188.27	$202.64
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $25.73 / $34.94 / $47.36	Professional	26	$25.73	$34.94	$47.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $118.99 / $179.69 / $246.24	Professional	TC	$118.99	$179.69	$246.24
Providence Facility/Professional Facility Modifier Low / Median / High Price $124.32 / $263.58 / $361.76	Facility		$124.32	$263.58	$361.76
Providence Facility/Professional Professional Modifier Low / Median / High Price $211.20 / $266.88 / $348.23	Professional		$211.20	$266.88	$348.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $46.17 / $60.97	Professional	26	$28.54	$46.17	$60.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $135.18 / $218.21 / $290.10	Professional	TC	$135.18	$218.21	$290.10
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $291.56 / $385.75 / $463.05	Facility		$291.56	$385.75	$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 Facility Modifier TC Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	TC	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.00 / $280.44 / $339.21	Professional		$208.00	$280.44	$339.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $39.65 / $48.39 / $59.69	Professional	26	$39.65	$48.39	$59.69
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $168.75 / $232.49 / $279.51	Professional	TC	$168.75	$232.49	$279.51
United Facility/Professional Professional Modifier Low / Median / High Price $141.91 / $238.05 / $355.57	Professional		$141.91	$238.05	$355.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.57 / $42.85 / $65.27	Professional	26	$24.57	$42.85	$65.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.97 / $192.37 / $303.02	Professional	TC	$110.97	$192.37	$303.02