Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.16 / $196.09 / $235.55	Professional		$92.16	$196.09	$235.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.03 / $24.63 / $48.72	Professional	26	$18.03	$24.63	$48.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.81 / $175.03 / $323.66	Professional	TC	$67.81	$175.03	$323.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.30 / $130.53 / $333.93	Professional		$70.30	$130.53	$333.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.75 / $26.76 / $43.69	Professional	26	$14.75	$26.76	$43.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.55 / $103.77 / $274.74	Professional	TC	$55.55	$103.77	$274.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $185.63 / $384.50 / $548.05	Professional		$185.63	$384.50	$548.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.82 / $45.20 / $64.42	Professional	26	$21.82	$45.20	$64.42
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $163.81 / $339.30 / $483.63	Professional	TC	$163.81	$339.30	$483.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $211.50 / $314.33 / $618.54	Professional		$211.50	$314.33	$618.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.78 / $39.82 / $72.16	Professional	26	$32.78	$39.82	$72.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $248.20 / $301.51 / $546.38	Professional	TC	$248.20	$301.51	$546.38
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.36 / $45.19 / $48.99	Facility	26	$35.36	$45.19	$48.99
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.94 / $48.91 / $87.78	Professional	26	$28.94	$48.91	$87.78
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $94.21 / $162.81 / $291.45	Professional	TC	$94.21	$162.81	$291.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $197.54 / $389.79 / $585.88	Professional		$197.54	$389.79	$585.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.75 / $26.76 / $48.85	Professional	26	$14.75	$26.76	$48.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.55 / $146.18 / $313.99	Professional	TC	$55.55	$146.18	$313.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $360.30 / $400.16 / $645.07	Professional		$360.30	$400.16	$645.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.30 / $48.40 / $73.54	Professional	26	$41.30	$48.40	$73.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $319.00 / $351.76 / $572.45	Professional	TC	$319.00	$351.76	$572.45
United Facility/Professional Professional Modifier Low / Median / High Price $109.78 / $182.97 / $634.51	Professional		$109.78	$182.97	$634.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.59 / $24.55 / $76.34	Professional	26	$15.59	$24.55	$76.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.19 / $156.99 / $561.79	Professional	TC	$94.19	$156.99	$561.79