Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $134.90 / $144.54	Facility	26	$74.13	$134.90	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $371.54	Professional		$151.36	$186.21	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $165.96	Professional	26	$52.48	$66.07	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $120.23 / $245.47	Professional	TC	$95.50	$120.23	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $588.84 / $912.01	Professional		$323.59	$588.84	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $165.96	Professional	26	$64.57	$109.65	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $489.78 / $758.58	Professional	TC	$263.03	$489.78	$758.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $645.65 / $794.33	Professional		$524.81	$645.65	$794.33
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $123.03 / $147.91	Professional	26	$95.50	$123.03	$147.91
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $537.03 / $645.65	Professional	TC	$436.52	$537.03	$645.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $602.56 / $812.83	Professional		$467.74	$602.56	$812.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $120.23 / $173.78	Professional	26	$87.10	$120.23	$173.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $512.86 / $691.83	Professional	TC	$288.40	$512.86	$691.83
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $114.82 / $117.49	Facility	26	$95.50	$114.82	$117.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $125.89	Professional	26	$69.18	$100.00	$125.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $446.68 / $562.34	Professional	TC	$309.03	$446.68	$562.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $660.69 / $891.25	Professional		$478.63	$660.69	$891.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $114.82 / $158.49	Professional	26	$77.62	$114.82	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $512.86 / $707.95	Professional	TC	$338.84	$512.86	$707.95
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $691.83 / $851.14	Professional		$537.03	$691.83	$851.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $123.03 / $158.49	Professional	26	$102.33	$123.03	$158.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $562.34 / $691.83	Professional	TC	$426.58	$562.34	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $562.34 / $870.96	Professional		$316.23	$562.34	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $107.15 / $162.18	Professional	26	$61.66	$107.15	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $457.09 / $707.95	Professional	TC	$257.04	$457.09	$707.95