Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.56 / $126.41 / $216.17	Professional		$94.56	$126.41	$216.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.17 / $51.04 / $109.87	Professional	26	$33.17	$51.04	$109.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.39 / $82.57 / $163.40	Professional	TC	$61.39	$82.57	$163.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $140.47 / $205.31	Professional		$73.48	$140.47	$205.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.79 / $50.66 / $74.48	Professional	26	$28.79	$50.66	$74.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.69 / $90.34 / $136.07	Professional	TC	$44.69	$90.34	$136.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $110.88 / $229.67 / $327.36	Professional		$110.88	$229.67	$327.36
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $40.19 / $83.25 / $118.66	Professional	26	$40.19	$83.25	$118.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $70.69 / $146.41 / $208.71	Professional	TC	$70.69	$146.41	$208.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $185.20 / $256.68 / $368.15	Professional		$185.20	$256.68	$368.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.70 / $95.01 / $132.61	Professional	26	$66.70	$95.01	$132.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $118.49 / $168.75 / $235.54	Professional	TC	$118.49	$168.75	$235.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $68.34 / $83.24 / $107.90	Facility	26	$68.34	$83.24	$107.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $76.89 / $97.33 / $134.30	Professional	26	$76.89	$97.33	$134.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $119.04 / $156.75 / $213.38	Professional	TC	$119.04	$156.75	$213.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.26 / $240.04 / $347.26	Professional		$141.26	$240.04	$347.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.94 / $50.66 / $80.95	Professional	26	$33.94	$50.66	$80.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $61.82 / $103.50 / $149.05	Professional	TC	$61.82	$103.50	$149.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $210.67 / $242.69 / $382.34	Professional		$210.67	$242.69	$382.34
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $76.01 / $85.89 / $135.36	Professional	26	$76.01	$85.89	$135.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $134.66 / $156.79 / $247.78	Professional	TC	$134.66	$156.79	$247.78
United Facility/Professional Professional Modifier Low / Median / High Price $77.52 / $129.19 / $371.00	Professional		$77.52	$129.19	$371.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.94 / $45.19 / $133.87	Professional	26	$27.94	$45.19	$133.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.58 / $65.97 / $237.13	Professional	TC	$49.58	$65.97	$237.13