Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $140.00 / $230.00	Professional		$70.00	$140.00	$230.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $36.21 / $61.85	Professional	26	$17.05	$36.21	$61.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.49 / $95.19 / $169.81	Professional	TC	$51.49	$95.19	$169.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $99.56 / $227.63	Professional		$44.27	$99.56	$227.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.71 / $38.57 / $60.06	Professional	26	$20.71	$38.57	$60.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.65 / $60.99 / $177.47	Professional	TC	$23.65	$60.99	$177.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.10 / $286.05 / $407.73	Professional		$138.10	$286.05	$407.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.39 / $69.16 / $98.58	Professional	26	$33.39	$69.16	$98.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $216.89 / $309.14	Professional	TC	$104.71	$216.89	$309.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $150.87 / $231.10 / $459.40	Professional		$150.87	$231.10	$459.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.51 / $76.80 / $110.34	Professional	26	$55.51	$76.80	$110.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.00 / $175.59 / $349.06	Professional	TC	$66.00	$175.59	$349.06
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $50.00 / $69.17 / $74.70	Facility	26	$50.00	$69.17	$74.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.24 / $60.32 / $85.28	Professional	26	$48.24	$60.32	$85.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $71.15 / $121.69 / $224.90	Professional	TC	$71.15	$121.69	$224.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $146.33 / $289.92 / $436.50	Professional		$146.33	$289.92	$436.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.65 / $38.57 / $66.81	Professional	26	$24.65	$38.57	$66.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.78 / $95.93 / $202.82	Professional	TC	$37.78	$95.93	$202.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $271.12 / $285.39 / $482.81	Professional		$271.12	$285.39	$482.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.24 / $70.90 / $111.07	Professional	26	$62.24	$70.90	$111.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $208.88 / $219.87 / $371.96	Professional	TC	$208.88	$219.87	$371.96
United Facility/Professional Professional Modifier Low / Median / High Price $77.09 / $128.47 / $477.47	Professional		$77.09	$128.47	$477.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $56.30 / $109.61	Professional	26	$22.52	$56.30	$109.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.57 / $69.09 / $367.86	Professional	TC	$54.57	$69.09	$367.86