Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.58 / $209.64 / $605.20	Professional		$67.58	$209.64	$605.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $29.22 / $80.04	Professional	26	$21.57	$29.22	$80.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.86 / $83.65 / $169.08	Professional	TC	$29.86	$83.65	$169.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.29 / $76.75 / $164.49	Professional		$34.29	$76.75	$164.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.75 / $30.84 / $46.30	Professional	26	$13.75	$30.84	$46.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.30 / $45.91 / $125.96	Professional	TC	$20.30	$45.91	$125.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $105.61 / $218.75 / $311.80	Professional		$105.61	$218.75	$311.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.95 / $55.82 / $79.56	Professional	26	$26.95	$55.82	$79.56
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $162.94 / $232.27	Professional	TC	$78.67	$162.94	$232.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $159.53 / $193.80 / $351.19	Professional		$159.53	$193.80	$351.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $49.18 / $89.12	Professional	26	$40.47	$49.18	$89.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.05 / $144.62 / $262.07	Professional	TC	$119.05	$144.62	$262.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.77 / $55.82 / $56.28	Facility	26	$33.77	$55.82	$56.28
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $36.95 / $47.88 / $56.28	Professional	26	$36.95	$47.88	$56.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $70.11 / $112.66 / $172.86	Professional	TC	$70.11	$112.66	$172.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $111.18 / $222.08 / $331.74	Professional		$111.18	$222.08	$331.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.75 / $30.84 / $48.50	Professional	26	$13.75	$30.84	$48.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.97 / $71.14 / $132.43	Professional	TC	$20.97	$71.14	$132.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $207.68 / $218.61 / $369.83	Professional		$207.68	$218.61	$369.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.27 / $57.26 / $89.71	Professional	26	$50.27	$57.26	$89.71
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $157.41 / $165.69 / $280.31	Professional	TC	$157.41	$165.69	$280.31
United Facility/Professional Professional Modifier Low / Median / High Price $56.51 / $94.19 / $365.74	Professional		$56.51	$94.19	$365.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.19 / $29.89 / $88.55	Professional	26	$18.19	$29.89	$88.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.32 / $63.87 / $277.19	Professional	TC	$38.32	$63.87	$277.19