Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.70 / $106.49 / $205.22	Professional		$70.70	$106.49	$205.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.79 / $28.40 / $61.07	Professional	26	$22.79	$28.40	$61.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.91 / $78.08 / $144.68	Professional	TC	$47.91	$78.08	$144.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $116.32 / $185.07	Professional		$36.65	$116.32	$185.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $34.46 / $46.73	Professional	26	$12.96	$34.46	$46.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.70 / $81.86 / $140.62	Professional	TC	$23.70	$81.86	$140.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.12 / $259.16 / $369.41	Professional		$125.12	$259.16	$369.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $31.78 / $65.83 / $93.83	Professional	26	$31.78	$65.83	$93.83
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $93.34 / $193.34 / $275.58	Professional	TC	$93.34	$193.34	$275.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $188.93 / $229.51 / $415.90	Professional		$188.93	$229.51	$415.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.71 / $57.96 / $105.03	Professional	26	$47.71	$57.96	$105.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.22 / $171.55 / $310.88	Professional	TC	$141.22	$171.55	$310.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.79 / $62.31 / $64.98	Facility	26	$37.79	$62.31	$64.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.68 / $47.67 / $68.36	Professional	26	$42.68	$47.67	$68.36
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $126.10 / $158.40 / $181.55	Professional	TC	$126.10	$158.40	$181.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $124.37 / $230.85 / $344.58	Professional		$124.37	$230.85	$344.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $34.46 / $53.41	Professional	26	$14.59	$34.46	$53.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.86 / $81.86 / $147.85	Professional	TC	$34.86	$81.86	$147.85
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $217.85 / $231.10 / $411.18	Professional		$217.85	$231.10	$411.18
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.46 / $63.40 / $103.60	Professional	26	$57.46	$63.40	$103.60
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $160.40 / $168.84 / $307.58	Professional	TC	$160.40	$168.84	$307.58
United Facility/Professional Professional Modifier Low / Median / High Price $69.94 / $116.57 / $383.66	Professional		$69.94	$116.57	$383.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $34.15 / $101.18	Professional	26	$20.35	$34.15	$101.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.59 / $83.32 / $282.48	Professional	TC	$49.59	$83.32	$282.48