Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $169.82 / $602.56	Professional		$70.79	$169.82	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $44.67 / $537.03	Professional	26	$21.88	$44.67	$537.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $83.18 / $169.82	Professional	TC	$44.67	$83.18	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $97.72 / $165.96	Professional		$34.67	$97.72	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $23.99 / $46.77	Professional	26	$13.80	$23.99	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $74.13 / $125.89	Professional	TC	$20.89	$74.13	$125.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $213.80 / $302.00	Professional		$107.15	$213.80	$302.00
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $54.95 / $77.62	Professional	26	$27.54	$54.95	$77.62
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $158.49 / $229.09	Professional	TC	$79.43	$158.49	$229.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $194.98 / $380.19	Professional		$109.65	$194.98	$380.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $50.12 / $93.33	Professional	26	$26.30	$50.12	$93.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $144.54 / $288.40	Professional	TC	$81.28	$144.54	$288.40
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $56.23 / $56.23	Facility	26	$45.71	$56.23	$56.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $61.66	Professional	26	$33.88	$45.71	$61.66
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $123.03 / $162.18	Professional	TC	$57.54	$123.03	$162.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $173.78 / $338.84	Professional		$85.11	$173.78	$338.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $28.84 / $81.28	Professional	26	$15.14	$28.84	$81.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $77.62 / $239.88	Professional	TC	$21.88	$77.62	$239.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $363.08	Professional		$138.04	$218.78	$363.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $57.54 / $89.13	Professional	26	$33.88	$57.54	$89.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $165.96 / $275.42	Professional	TC	$91.20	$165.96	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $93.33 / $363.08	Professional		$56.23	$93.33	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $30.20 / $89.13	Professional	26	$17.38	$30.20	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $64.57 / $275.42	Professional	TC	$38.02	$64.57	$275.42