Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.04 / $130.69 / $167.25	Professional		$98.04	$130.69	$167.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.61 / $16.25 / $20.92	Professional	26	$13.61	$16.25	$20.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.23 / $115.53 / $148.33	Professional	TC	$84.23	$115.53	$148.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.76 / $183.18 / $369.98	Professional		$109.76	$183.18	$369.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.82 / $27.37 / $41.65	Professional	26	$15.82	$27.37	$41.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.00 / $158.21 / $331.09	Professional	TC	$95.00	$158.21	$331.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $140.04 / $281.54 / $334.05	Professional		$140.04	$281.54	$334.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $31.37 / $35.11	Professional	26	$14.72	$31.37	$35.11
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $125.32 / $250.15 / $298.94	Professional	TC	$125.32	$250.15	$298.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $143.46 / $182.70 / $267.70	Professional		$143.46	$182.70	$267.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.94 / $23.85 / $36.00	Professional	26	$15.94	$23.85	$36.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.69 / $169.65 / $261.88	Professional	TC	$120.69	$169.65	$261.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $20.35 / $28.14 / $29.48	Facility	26	$20.35	$28.14	$29.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $24.94 / $29.51	Professional	26	$19.14	$24.94	$29.51
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $105.00 / $138.06 / $189.10	Professional	TC	$105.00	$138.06	$189.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $130.37 / $208.53 / $337.33	Professional		$130.37	$208.53	$337.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.82 / $28.24 / $41.65	Professional	26	$15.82	$28.24	$41.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.70 / $160.66 / $331.09	Professional	TC	$95.70	$160.66	$331.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $146.43 / $239.97 / $350.58	Professional		$146.43	$239.97	$350.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $17.00 / $27.86 / $40.70	Professional	26	$17.00	$27.86	$40.70
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $129.43 / $212.12 / $309.88	Professional	TC	$129.43	$212.12	$309.88
United Facility/Professional Professional Modifier Low / Median / High Price $119.70 / $179.55 / $333.31	Professional		$119.70	$179.55	$333.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $24.95 / $42.32	Professional	26	$15.92	$24.95	$42.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.36 / $155.03 / $296.45	Professional	TC	$103.36	$155.03	$296.45