Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $144.54 / $257.04	Professional		$93.33	$144.54	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.02 / $97.72	Professional	26	$26.92	$38.02	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $107.15 / $204.17	Professional	TC	$51.29	$107.15	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $128.82 / $229.09	Professional		$44.67	$128.82	$229.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $29.51 / $60.26	Professional	26	$19.05	$29.51	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $100.00 / $177.83	Professional	TC	$25.12	$100.00	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $275.42 / $398.11	Professional		$134.90	$275.42	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $66.07 / $95.50	Professional	26	$33.11	$66.07	$95.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $204.17 / $302.00	Professional	TC	$102.33	$204.17	$302.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $213.80 / $457.09	Professional		$141.25	$213.80	$457.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $75.86 / $114.82	Professional	26	$36.31	$75.86	$114.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $169.82 / $380.19	Professional	TC	$66.07	$169.82	$380.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $69.18 / $75.86	Facility	26	$57.54	$69.18	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $69.18 / $81.28	Professional	26	$42.66	$69.18	$81.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $104.71 / $234.42	Professional	TC	$74.13	$104.71	$234.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $234.42 / $457.09	Professional		$112.20	$234.42	$457.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $37.15 / $102.33	Professional	26	$24.55	$37.15	$102.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $117.49 / $323.59	Professional	TC	$38.02	$117.49	$323.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $288.40 / $478.63	Professional		$177.83	$288.40	$478.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $70.79 / $109.65	Professional	26	$41.69	$70.79	$109.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $218.78 / $371.54	Professional	TC	$120.23	$218.78	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $128.82 / $478.63	Professional		$77.62	$128.82	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $37.15 / $109.65	Professional	26	$22.39	$37.15	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $91.20 / $371.54	Professional	TC	$54.95	$91.20	$371.54