Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $130.61 / $151.44 / $307.35	Facility	26	$130.61	$151.44	$307.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.75 / $494.68 / $600.79	Professional		$226.75	$494.68	$600.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $62.28 / $156.13	Professional	26	$52.95	$62.28	$156.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.34 / $438.50 / $475.57	Professional	TC	$166.34	$438.50	$475.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $349.34 / $521.82 / $641.42	Professional		$349.34	$521.82	$641.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.87 / $127.74 / $173.01	Professional	26	$89.87	$127.74	$173.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $255.12 / $382.82 / $473.99	Professional	TC	$255.12	$382.82	$473.99
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $438.44 / $512.57 / $593.87	Professional		$438.44	$512.57	$593.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $116.60 / $140.38 / $157.93	Professional	26	$116.60	$140.38	$157.93
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $321.83 / $371.26 / $435.94	Professional	TC	$321.83	$371.26	$435.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $344.00 / $382.91 / $833.19	Professional		$344.00	$382.91	$833.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.66 / $137.29 / $194.14	Professional	26	$97.66	$137.29	$194.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.38 / $358.02 / $941.85	Professional	TC	$251.38	$358.02	$941.85
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.22 / $119.68 / $121.94	Facility	26	$87.22	$119.68	$121.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $71.59 / $105.60 / $127.61	Professional	26	$71.59	$105.60	$127.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $191.35 / $304.18 / $722.10	Professional	TC	$191.35	$304.18	$722.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $372.29 / $516.69 / $644.08	Professional		$372.29	$516.69	$644.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.99 / $127.74 / $173.01	Professional	26	$81.99	$127.74	$173.01
Providence Facility/Professional Professional Modifier 52 Low / Median / High Price $259.79 / $261.75 / $261.75	Professional	52	$259.79	$261.75	$261.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $224.24 / $352.61 / $469.06	Professional	TC	$224.24	$352.61	$469.06
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $406.26 / $526.46 / $636.72	Professional		$406.26	$526.46	$636.72
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.75 / $145.29 / $173.39	Professional	26	$109.75	$145.29	$173.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $298.89 / $380.81 / $463.33	Professional	TC	$298.89	$380.81	$463.33
United Facility/Professional Professional Modifier Low / Median / High Price $191.12 / $394.20 / $714.93	Professional		$191.12	$394.20	$714.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.45 / $102.84 / $202.48	Professional	26	$53.45	$102.84	$202.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $135.00 / $347.48 / $541.08	Professional	TC	$135.00	$347.48	$541.08