Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.43 / $217.74 / $323.11	Facility	26	$169.43	$217.74	$323.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $212.72 / $289.51 / $767.16	Professional		$212.72	$289.51	$767.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.34 / $141.13 / $408.65	Professional	26	$120.34	$141.13	$408.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $617.00 / $617.00 / $617.00	Professional	50	$617.00	$617.00	$617.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.74 / $101.36 / $191.05	Professional	TC	$83.74	$101.36	$191.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.38 / $458.53 / $622.48	Professional		$289.38	$458.53	$622.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $168.93 / $271.10 / $370.52	Professional	26	$168.93	$271.10	$370.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.67 / $192.19 / $258.12	Professional	TC	$119.67	$192.19	$258.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.44 / $484.30 / $554.35	Professional		$371.44	$484.30	$554.35
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $227.87 / $297.11 / $335.18	Professional	26	$227.87	$297.11	$335.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $143.57 / $186.68 / $219.18	Professional	TC	$143.57	$186.68	$219.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $332.51 / $403.04 / $640.47	Professional		$332.51	$403.04	$640.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $206.02 / $249.72 / $409.54	Professional	26	$206.02	$249.72	$409.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.49 / $153.32 / $251.44	Professional	TC	$126.49	$153.32	$251.44
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $185.56 / $255.05 / $258.62	Facility	26	$185.56	$255.05	$258.62
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $164.69 / $212.30 / $271.93	Professional	26	$164.69	$212.30	$271.93
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $116.40 / $151.63 / $196.37	Professional	TC	$116.40	$151.63	$196.37
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $289.92 / $465.33 / $608.00	Professional		$289.92	$465.33	$608.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $174.86 / $271.10 / $370.52	Professional	26	$174.86	$271.10	$370.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $119.67 / $195.04 / $261.69	Professional	TC	$119.67	$195.04	$261.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,497.68 / $1,497.68 / $1,497.68	Facility	26	$1,497.68	$1,497.68	$1,497.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $340.20 / $434.34 / $596.91	Professional		$340.20	$434.34	$596.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $206.82 / $255.27 / $362.89	Professional	26	$206.82	$255.27	$362.89
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $133.38 / $180.70 / $234.03	Professional	TC	$133.38	$180.70	$234.03
United Facility/Professional Professional Modifier Low / Median / High Price $337.48 / $447.81 / $664.57	Professional		$337.48	$447.81	$664.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $194.95 / $276.89 / $403.69	Professional	26	$194.95	$276.89	$403.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.28 / $187.60 / $263.70	Professional	TC	$123.28	$187.60	$263.70