Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.45 / $303.91 / $461.22	Professional		$198.45	$303.91	$461.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.39 / $45.23 / $131.35	Professional	26	$32.39	$45.23	$131.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $157.29 / $212.67 / $696.04	Professional	TC	$157.29	$212.67	$696.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.20 / $368.66 / $417.85	Professional		$101.20	$368.66	$417.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.08 / $47.00 / $66.98	Professional	26	$22.08	$47.00	$66.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.86 / $321.66 / $362.10	Professional	TC	$77.86	$321.66	$362.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $260.66 / $539.91 / $769.57	Professional		$260.66	$539.91	$769.57
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $80.56 / $114.85	Professional	26	$38.90	$80.56	$114.85
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $221.76 / $459.34 / $654.73	Professional	TC	$221.76	$459.34	$654.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $393.76 / $598.29 / $866.81	Professional		$393.76	$598.29	$866.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.32 / $70.84 / $128.38	Professional	26	$58.32	$70.84	$128.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $335.44 / $407.49 / $738.43	Professional	TC	$335.44	$407.49	$738.43
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $54.18 / $80.58 / $85.76	Facility	26	$54.18	$80.58	$85.76
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.04 / $74.15 / $86.43	Professional	26	$49.04	$74.15	$86.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $382.78 / $459.33 / $592.28	Professional	TC	$382.78	$459.33	$592.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $358.74 / $617.60 / $860.41	Professional		$358.74	$617.60	$860.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.45 / $47.00 / $73.91	Professional	26	$25.45	$47.00	$73.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.92 / $321.66 / $380.70	Professional	TC	$102.92	$321.66	$380.70
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $541.04 / $673.57 / $963.48	Professional		$541.04	$673.57	$963.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $74.20 / $85.89 / $132.16	Professional	26	$74.20	$85.89	$132.16
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $466.83 / $578.35 / $831.32	Professional	TC	$466.83	$578.35	$831.32
United Facility/Professional Professional Modifier Low / Median / High Price $172.36 / $348.26 / $952.82	Professional		$172.36	$348.26	$952.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.71 / $27.72 / $130.69	Professional	26	$27.71	$27.72	$130.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.24 / $273.26 / $822.12	Professional	TC	$181.24	$273.26	$822.12