Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $134.90 / $346.74	Professional		$83.18	$134.90	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $87.10 / $181.97	Professional	26	$67.61	$87.10	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $61.66	Professional	TC	$20.89	$30.20	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $100.00 / $194.98	Professional		$63.10	$100.00	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $74.13 / $144.54	Professional	26	$40.74	$74.13	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $26.92 / $52.48	Professional	TC	$21.38	$26.92	$52.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $223.87 / $323.59	Professional		$112.20	$223.87	$323.59
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $165.96 / $234.42	Professional	26	$83.18	$165.96	$234.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $58.88 / $85.11	Professional	TC	$29.51	$58.88	$85.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $204.17 / $371.54	Professional		$91.20	$204.17	$371.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $151.36 / $275.42	Professional	26	$87.10	$151.36	$275.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $95.50	Professional	TC	$44.67	$61.66	$95.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $165.96 / $169.82	Facility	26	$123.03	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $128.82 / $173.78	Professional	26	$100.00	$128.82	$173.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $66.07 / $100.00	Professional	TC	$40.74	$66.07	$100.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $223.87 / $346.74	Professional		$97.72	$223.87	$346.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $89.13 / $251.19	Professional	26	$50.12	$89.13	$251.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $32.36 / $107.15	Professional	TC	$22.91	$32.36	$107.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $223.87 / $363.08	Professional		$138.04	$223.87	$363.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $269.15	Professional	26	$102.33	$169.82	$269.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $53.70 / $89.13	Professional	TC	$35.48	$53.70	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $117.49 / $354.81	Professional		$70.79	$117.49	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $269.15	Professional	26	$51.29	$91.20	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $30.20 / $93.33	Professional	TC	$15.85	$30.20	$93.33