Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $186.21 / $354.81	Professional		$91.20	$186.21	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $23.99 / $47.86	Professional	26	$18.20	$23.99	$47.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $173.78 / $323.59	Professional	TC	$134.90	$173.78	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $173.78 / $331.13	Professional		$70.79	$173.78	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $23.44 / $43.65	Professional	26	$13.18	$23.44	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $154.88 / $275.42	Professional	TC	$54.95	$154.88	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $371.54 / $537.03	Professional		$186.21	$371.54	$537.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $43.65 / $63.10	Professional	26	$21.88	$43.65	$63.10
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $331.13 / $478.63	Professional	TC	$165.96	$331.13	$478.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $338.84 / $660.69	Professional		$213.80	$338.84	$660.69
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $39.81 / $75.86	Professional	26	$33.11	$39.81	$75.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $302.00 / $588.84	Professional	TC	$223.87	$302.00	$588.84
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $45.71 / $100.00	Facility	26	$37.15	$45.71	$100.00
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $97.72	Professional	26	$35.48	$48.98	$97.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $186.21 / $338.84	Professional	TC	$134.90	$186.21	$338.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $331.13 / $616.60	Professional		$173.78	$331.13	$616.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $25.12 / $75.86	Professional	26	$14.79	$25.12	$75.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $177.83 / $512.86	Professional	TC	$54.95	$177.83	$512.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $380.19 / $645.65	Professional		$239.88	$380.19	$645.65
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $46.77 / $72.44	Professional	26	$26.92	$46.77	$72.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $338.84 / $562.34	Professional	TC	$204.17	$338.84	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $630.96	Professional		$109.65	$181.97	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $25.70 / $75.86	Professional	26	$15.49	$25.70	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $158.49 / $562.34	Professional	TC	$93.33	$158.49	$562.34