Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.05 / $139.63 / $242.51	Professional		$86.05	$139.63	$242.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.16 / $41.91 / $77.42	Professional	26	$31.16	$41.91	$77.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.88 / $98.22 / $165.09	Professional	TC	$54.88	$98.22	$165.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.41 / $128.46 / $255.95	Professional		$61.41	$128.46	$255.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.23 / $44.32 / $70.48	Professional	26	$23.23	$44.32	$70.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.40 / $84.14 / $188.72	Professional	TC	$33.40	$84.14	$188.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $142.63 / $295.43 / $421.10	Professional		$142.63	$295.43	$421.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $39.52 / $81.86 / $116.68	Professional	26	$39.52	$81.86	$116.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $103.11 / $213.57 / $304.42	Professional	TC	$103.11	$213.57	$304.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $215.44 / $300.16 / $474.26	Professional		$215.44	$300.16	$474.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.65 / $93.51 / $131.32	Professional	26	$65.65	$93.51	$131.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $168.84 / $189.69 / $343.74	Professional	TC	$168.84	$189.69	$343.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $56.35 / $79.95 / $85.91	Facility	26	$56.35	$79.95	$85.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $56.64 / $81.73 / $104.98	Professional	26	$56.64	$81.73	$104.98
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $104.90 / $211.58 / $263.98	Professional	TC	$104.90	$211.58	$263.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $143.97 / $271.36 / $428.34	Professional		$143.97	$271.36	$428.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.23 / $44.32 / $78.38	Professional	26	$23.23	$44.32	$78.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $38.18 / $101.26 / $206.87	Professional	TC	$38.18	$101.26	$206.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $253.76 / $267.91 / $474.19	Professional		$253.76	$267.91	$474.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.42 / $81.12 / $130.30	Professional	26	$72.42	$81.12	$130.30
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $181.35 / $190.89 / $343.90	Professional	TC	$181.35	$190.89	$343.90
United Facility/Professional Professional Modifier Low / Median / High Price $80.33 / $133.88 / $446.89	Professional		$80.33	$133.88	$446.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.99 / $43.31 / $127.52	Professional	26	$25.99	$43.31	$127.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.34 / $64.31 / $287.94	Professional	TC	$54.34	$64.31	$287.94