Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.93 / $125.57 / $278.54	Facility	26	$94.93	$125.57	$278.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.22 / $192.97 / $952.00	Professional		$162.22	$192.97	$952.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $77.18 / $297.00	Professional	26	$51.54	$77.18	$297.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.68 / $126.93 / $330.63	Professional	TC	$110.68	$126.93	$330.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $285.33 / $409.98 / $502.79	Professional		$285.33	$409.98	$502.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.13 / $125.59 / $161.86	Professional	26	$91.13	$125.59	$161.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.21 / $284.39 / $340.93	Professional	TC	$194.21	$284.39	$340.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $183.29 / $411.99 / $437.22	Professional		$183.29	$411.99	$437.22
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $55.03 / $126.90 / $131.27	Professional	26	$55.03	$126.90	$131.27
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $128.26 / $283.64 / $305.95	Professional	TC	$128.26	$283.64	$305.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $262.64 / $298.32 / $528.63	Professional		$262.64	$298.32	$528.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.61 / $113.23 / $176.14	Professional	26	$88.61	$113.23	$176.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.67 / $263.33 / $383.01	Professional	TC	$192.67	$263.33	$383.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $81.88 / $109.65 / $113.23	Facility	26	$81.88	$109.65	$113.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $316.77 / $351.98 / $351.98	Professional		$316.77	$351.98	$351.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $67.94 / $102.80 / $118.44	Professional	26	$67.94	$102.80	$118.44
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.50 / $207.06 / $241.20	Professional	TC	$141.50	$207.06	$241.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $262.64 / $386.84 / $481.85	Professional		$262.64	$386.84	$481.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.99 / $114.10 / $161.86	Professional	26	$88.99	$114.10	$161.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $189.64 / $244.86 / $340.93	Professional	TC	$189.64	$244.86	$340.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,526.97 / $1,526.97 / $1,526.97	Facility	26	$1,526.97	$1,526.97	$1,526.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $314.14 / $399.77 / $492.70	Professional		$314.14	$399.77	$492.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.26 / $131.94 / $156.34	Professional	26	$101.26	$131.94	$156.34
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $212.89 / $267.82 / $336.36	Professional	TC	$212.89	$267.82	$336.36
United Facility/Professional Professional Modifier Low / Median / High Price $153.63 / $194.66 / $553.22	Professional		$153.63	$194.66	$553.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $55.23 / $175.53	Professional	26	$51.23	$55.23	$175.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.02 / $122.63 / $377.69	Professional	TC	$102.02	$122.63	$377.69