Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $130.81 / $130.81 / $145.25	Facility	26	$130.81	$130.81	$145.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.75 / $187.37 / $440.90	Professional		$155.75	$187.37	$440.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $65.36 / $149.28	Professional	26	$53.70	$65.36	$149.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.94 / $124.22 / $294.75	Professional	TC	$101.94	$124.22	$294.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $357.61 / $668.54 / $965.68	Professional		$357.61	$668.54	$965.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.59 / $121.18 / $175.94	Professional	26	$65.59	$121.18	$175.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $290.69 / $541.84 / $794.57	Professional	TC	$290.69	$541.84	$794.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $561.11 / $653.91 / $800.53	Professional		$561.11	$653.91	$800.53
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $109.70 / $129.13 / $149.80	Professional	26	$109.70	$129.13	$149.80
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $450.31 / $526.90 / $650.73	Professional	TC	$450.31	$526.90	$650.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $468.07 / $573.03 / $930.47	Professional		$468.07	$573.03	$930.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.33 / $113.04 / $183.55	Professional	26	$92.33	$113.04	$183.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $375.74 / $464.55 / $746.92	Professional	TC	$375.74	$464.55	$746.92
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $82.85 / $113.90 / $116.58	Facility	26	$82.85	$113.90	$116.58
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $68.40 / $95.76 / $120.56	Professional	26	$68.40	$95.76	$120.56
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $313.56 / $437.78 / $552.03	Professional	TC	$313.56	$437.78	$552.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $555.03 / $699.19 / $901.77	Professional		$555.03	$699.19	$901.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $75.09 / $125.19 / $164.35	Professional	26	$75.09	$125.19	$164.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $333.09 / $570.55 / $759.95	Professional	TC	$333.09	$570.55	$759.95
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 Professional Modifier Low / Median / High Price $591.02 / $756.53 / $903.92	Professional		$591.02	$756.53	$903.92
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $103.80 / $135.81 / $163.92	Professional	26	$103.80	$135.81	$163.92
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $485.76 / $622.48 / $740.00	Professional	TC	$485.76	$622.48	$740.00
United Facility/Professional Professional Modifier Low / Median / High Price $333.85 / $616.70 / $950.08	Professional		$333.85	$616.70	$950.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.69 / $114.56 / $177.11	Professional	26	$66.69	$114.56	$177.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $262.35 / $497.01 / $748.99	Professional	TC	$262.35	$497.01	$748.99