Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.13 / $118.08 / $258.00	Professional		$76.13	$118.08	$258.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.34 / $33.71 / $63.15	Professional	26	$25.34	$33.71	$63.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.20 / $84.37 / $202.45	Professional	TC	$50.20	$84.37	$202.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.60 / $114.00 / $193.31	Professional		$60.60	$114.00	$193.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $37.07 / $61.68	Professional	26	$20.00	$37.07	$61.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $76.93 / $140.18	Professional	TC	$40.60	$76.93	$140.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.29 / $216.02 / $307.91	Professional		$104.29	$216.02	$307.91
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $30.84 / $63.88 / $91.05	Professional	26	$30.84	$63.88	$91.05
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $73.45 / $152.13 / $216.85	Professional	TC	$73.45	$152.13	$216.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $174.52 / $248.56 / $391.30	Professional		$174.52	$248.56	$391.30
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $72.97 / $121.94	Professional	26	$51.23	$72.97	$121.94
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.29 / $175.59 / $273.70	Professional	TC	$123.29	$175.59	$273.70
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.42 / $63.87 / $68.87	Facility	26	$42.42	$63.87	$68.87
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.67 / $67.67 / $108.58	Professional	26	$48.67	$67.67	$108.58
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $106.93 / $132.66 / $307.23	Professional	TC	$106.93	$132.66	$307.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.14 / $223.74 / $334.00	Professional		$114.14	$223.74	$334.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $37.07 / $65.09	Professional	26	$20.00	$37.07	$65.09
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $82.15 / $153.55	Professional	TC	$40.60	$82.15	$153.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $202.89 / $226.32 / $361.31	Professional		$202.89	$226.32	$361.31
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $58.05 / $66.12 / $103.38	Professional	26	$58.05	$66.12	$103.38
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $144.84 / $159.91 / $257.92	Professional	TC	$144.84	$159.91	$257.92
United Facility/Professional Professional Modifier Low / Median / High Price $66.91 / $69.08 / $357.31	Professional		$66.91	$69.08	$357.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.44 / $34.51 / $107.33	Professional	26	$21.44	$34.51	$107.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $79.40 / $267.77	Professional	TC	$47.64	$79.40	$267.77