Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $512.86	Professional		$204.17	$295.12	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $44.67 / $117.49	Professional	26	$33.11	$44.67	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $251.19 / $676.08	Professional	TC	$169.82	$251.19	$676.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $245.47 / $416.87	Professional		$114.82	$245.47	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $67.61	Professional	26	$21.88	$34.67	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $208.93 / $363.08	Professional	TC	$89.13	$208.93	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $537.03 / $758.58	Professional		$263.03	$537.03	$758.58
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $79.43 / $112.20	Professional	26	$38.90	$79.43	$112.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $457.09 / $645.65	Professional	TC	$223.87	$457.09	$645.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $512.86 / $1,000.00	Professional		$371.54	$512.86	$1,000.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $138.04	Professional	26	$43.65	$70.79	$138.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $407.38 / $851.14	Professional	TC	$316.23	$407.38	$851.14
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $81.28 / $87.10	Facility	26	$66.07	$81.28	$87.10
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $87.10	Professional	26	$48.98	$66.07	$87.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $380.19 / $549.54	Professional	TC	$331.13	$380.19	$549.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $575.44 / $851.14	Professional		$245.47	$575.44	$851.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $117.49	Professional	26	$25.70	$43.65	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $269.15 / $676.08	Professional	TC	$134.90	$269.15	$676.08
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $645.65 / $933.25	Professional		$346.74	$645.65	$933.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $85.11 / $128.82	Professional	26	$48.98	$85.11	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $562.34 / $794.33	Professional	TC	$295.12	$562.34	$794.33
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $323.59 / $954.99	Professional		$173.78	$323.59	$954.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $43.65 / $131.83	Professional	26	$26.92	$43.65	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $275.42 / $812.83	Professional	TC	$147.91	$275.42	$812.83