Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $269.15	Professional		$107.15	$138.04	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $44.67 / $72.44	Professional	26	$32.36	$44.67	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $97.72 / $208.93	Professional	TC	$75.86	$97.72	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $131.83 / $257.04	Professional		$61.66	$131.83	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $38.02 / $70.79	Professional	26	$21.88	$38.02	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $97.72 / $190.55	Professional	TC	$38.02	$97.72	$190.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $288.40 / $416.87	Professional		$144.54	$288.40	$416.87
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $79.43 / $114.82	Professional	26	$39.81	$79.43	$114.82
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $208.93 / $302.00	Professional	TC	$104.71	$208.93	$302.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $302.00 / $467.74	Professional		$177.83	$302.00	$467.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $131.83	Professional	26	$56.23	$91.20	$131.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $190.55 / $331.13	Professional	TC	$158.49	$190.55	$331.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $81.28 / $117.49	Facility	26	$67.61	$81.28	$117.49
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $79.43 / $107.15	Professional	26	$53.70	$79.43	$107.15
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $147.91 / $275.42	Professional	TC	$100.00	$147.91	$275.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $269.15 / $446.68	Professional		$131.83	$269.15	$446.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $42.66 / $120.23	Professional	26	$23.44	$42.66	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $109.65 / $316.23	Professional	TC	$40.74	$109.65	$316.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $269.15 / $457.09	Professional		$177.83	$269.15	$457.09
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $81.28 / $128.82	Professional	26	$48.98	$81.28	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $190.55 / $323.59	Professional	TC	$128.82	$190.55	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $134.90 / $446.68	Professional		$79.43	$134.90	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $128.82	Professional	26	$25.70	$43.65	$128.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $91.20 / $316.23	Professional	TC	$54.95	$91.20	$316.23