Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $131.83 / $154.88	Facility	26	$85.11	$131.83	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $371.54 / $562.34	Professional		$218.78	$371.54	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $67.61 / $138.04	Professional	26	$54.95	$67.61	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.84 / $489.78	Professional	TC	$158.49	$281.84	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $676.08	Professional		$331.13	$524.81	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $128.82 / $177.83	Professional	26	$85.11	$128.82	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $380.19 / $512.86	Professional	TC	$245.47	$380.19	$512.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $512.86 / $602.56	Professional		$239.88	$512.86	$602.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $138.04 / $158.49	Professional	26	$61.66	$138.04	$158.49
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $371.54 / $436.52	Professional	TC	$177.83	$371.54	$436.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $512.86 / $831.76	Professional		$363.08	$512.86	$831.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $194.98	Professional	26	$89.13	$138.04	$194.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $380.19 / $933.25	Professional	TC	$269.15	$380.19	$933.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $120.23 / $123.03	Facility	26	$100.00	$120.23	$123.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $131.83	Professional	26	$70.79	$104.71	$131.83
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $812.83	Professional	TC	$186.21	$302.00	$812.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $501.19 / $794.33	Professional		$371.54	$501.19	$794.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $120.23 / $173.78	Professional	26	$87.10	$120.23	$173.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $380.19 / $954.99	Professional	TC	$245.47	$380.19	$954.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $467.74 / $616.60	Professional		$407.38	$467.74	$616.60
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $165.96	Professional	26	$109.65	$128.82	$165.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $338.84 / $446.68	Professional	TC	$295.12	$338.84	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $457.09 / $676.08	Professional		$190.55	$457.09	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $64.57 / $177.83	Professional	26	$53.70	$64.57	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $363.08 / $524.81	Professional	TC	$138.04	$363.08	$524.81