Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $94.37 / $119.42 / $152.00	Professional		$94.37	$119.42	$152.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.91 / $84.89 / $108.67	Professional	26	$71.91	$84.89	$108.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.69 / $34.38 / $45.65	Professional	TC	$19.69	$34.38	$45.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.64 / $181.17 / $296.31	Professional		$106.64	$181.17	$296.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.12 / $143.81 / $218.06	Professional	26	$83.12	$143.81	$218.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.52 / $39.82 / $87.28	Professional	TC	$23.52	$39.82	$87.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.26 / $224.36 / $255.86	Professional		$107.26	$224.36	$255.86
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.34 / $162.66 / $182.13	Professional	26	$76.34	$162.66	$182.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.91 / $61.71 / $73.73	Professional	TC	$30.91	$61.71	$73.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $119.85 / $172.67 / $230.10	Professional		$119.85	$172.67	$230.10
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $82.24 / $121.16 / $197.10	Professional	26	$82.24	$121.16	$197.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.52 / $46.43 / $75.98	Professional	TC	$31.52	$46.43	$75.98
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $109.50 / $150.75 / $154.36	Facility	26	$109.50	$150.75	$154.36
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $90.45 / $124.85 / $155.94	Professional	26	$90.45	$124.85	$155.94
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $25.85 / $35.99 / $56.36	Professional	TC	$25.85	$35.99	$56.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $126.47 / $199.41 / $288.00	Professional		$126.47	$199.41	$288.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.12 / $149.49 / $218.06	Professional	26	$83.12	$149.49	$218.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.52 / $43.65 / $87.28	Professional	TC	$23.52	$43.65	$87.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.18 / $205.15 / $299.70	Professional		$125.18	$205.15	$299.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $88.47 / $145.00 / $212.70	Professional	26	$88.47	$145.00	$212.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $36.71 / $60.15 / $87.88	Professional	TC	$36.71	$60.15	$87.88
United Facility/Professional Professional Modifier Low / Median / High Price $108.78 / $176.32 / $311.29	Professional		$108.78	$176.32	$311.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.14 / $131.08 / $231.42	Professional	26	$88.14	$131.08	$231.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.03 / $44.46 / $82.02	Professional	TC	$28.03	$44.46	$82.02