Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.36 / $115.29 / $209.56	Professional		$82.36	$115.29	$209.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.40 / $80.70 / $118.46	Professional	26	$66.40	$80.70	$118.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.05 / $36.60 / $60.81	Professional	TC	$23.05	$36.60	$60.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.46 / $128.38 / $193.24	Professional		$57.46	$128.38	$193.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.04 / $93.19 / $145.51	Professional	26	$38.04	$93.19	$145.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.34 / $35.19 / $52.06	Professional	TC	$21.34	$35.19	$52.06
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $111.49 / $230.93 / $329.16	Professional		$111.49	$230.93	$329.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $82.89 / $171.69 / $244.72	Professional	26	$82.89	$171.69	$244.72
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.59 / $59.22 / $84.41	Professional	TC	$28.59	$59.22	$84.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $167.73 / $226.32 / $369.23	Professional		$167.73	$226.32	$369.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $118.59 / $156.78 / $273.72	Professional	26	$118.59	$156.78	$273.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.03 / $68.41 / $95.48	Professional	TC	$48.03	$68.41	$95.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $105.84 / $164.82 / $171.52	Facility	26	$105.84	$164.82	$171.52
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $88.55 / $151.19 / $185.24	Professional	26	$88.55	$151.19	$185.24
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $40.40 / $69.11 / $86.50	Professional	TC	$40.40	$69.11	$86.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.38 / $224.40 / $329.17	Professional		$128.38	$224.40	$329.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $93.19 / $145.77	Professional	26	$50.50	$93.19	$145.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.71 / $35.19 / $57.18	Professional	TC	$23.71	$35.19	$57.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $202.29 / $224.56 / $368.46	Professional		$202.29	$224.56	$368.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $152.02 / $171.11 / $273.41	Professional	26	$152.02	$171.11	$273.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.27 / $53.76 / $95.05	Professional	TC	$50.27	$53.76	$95.05
United Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $117.65 / $356.26	Professional		$70.59	$117.65	$356.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.57 / $90.38 / $267.70	Professional	26	$54.57	$90.38	$267.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $26.70 / $92.96	Professional	TC	$16.02	$26.70	$92.96