Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.78 / $63.42 / $97.56	Facility	26	$48.78	$63.42	$97.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $160.46 / $235.08 / $943.00	Professional		$160.46	$235.08	$943.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $63.40 / $237.97	Professional	26	$40.72	$63.40	$237.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.20 / $169.58 / $303.82	Professional	TC	$117.20	$169.58	$303.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.68 / $352.61 / $527.37	Professional		$204.68	$352.61	$527.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.18 / $83.88 / $124.54	Professional	26	$53.18	$83.88	$124.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $159.55 / $269.63 / $382.11	Professional	TC	$159.55	$269.63	$382.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.31 / $352.30 / $429.66	Professional		$302.31	$352.30	$429.66
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $70.52 / $83.46 / $96.30	Professional	26	$70.52	$83.46	$96.30
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $230.69 / $269.93 / $333.36	Professional	TC	$230.69	$269.93	$333.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $252.45 / $322.48 / $482.88	Professional		$252.45	$322.48	$482.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.78 / $79.45 / $118.83	Professional	26	$59.78	$79.45	$118.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.67 / $252.68 / $383.01	Professional	TC	$192.67	$252.68	$383.01
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $61.55 / $73.81 / $111.35	Facility	26	$61.55	$73.81	$111.35
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.41 / $76.38 / $110.08	Professional	26	$53.41	$76.38	$110.08
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $159.13 / $233.83 / $284.08	Professional	TC	$159.13	$233.83	$284.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $289.77 / $370.50 / $472.48	Professional		$289.77	$370.50	$472.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $84.08 / $124.54	Professional	26	$50.74	$84.08	$124.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.55 / $279.98 / $357.95	Professional	TC	$165.55	$279.98	$357.95
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 $300.76 / $387.40 / $450.06	Professional		$300.76	$387.40	$450.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $70.84 / $91.90 / $108.37	Professional	26	$70.84	$91.90	$108.37
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $229.84 / $285.10 / $343.94	Professional	TC	$229.84	$285.10	$343.94
United Facility/Professional Professional Modifier Low / Median / High Price $198.40 / $324.81 / $505.34	Professional		$198.40	$324.81	$505.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.16 / $83.45 / $129.27	Professional	26	$50.16	$83.45	$129.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.54 / $245.71 / $376.07	Professional	TC	$150.54	$245.71	$376.07