Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $66.07 / $154.88	Professional		$52.48	$66.07	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $26.92 / $60.26	Professional	26	$20.89	$26.92	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $39.81 / $112.20	Professional	TC	$30.90	$39.81	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $70.79 / $114.82	Professional		$34.67	$70.79	$114.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $22.91 / $46.77	Professional	26	$13.49	$22.91	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $47.86 / $75.86	Professional	TC	$16.22	$47.86	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $165.96 / $239.88	Professional		$83.18	$165.96	$239.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $53.70 / $75.86	Professional	26	$26.30	$53.70	$75.86
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $114.82 / $162.18	Professional	TC	$57.54	$114.82	$162.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $125.89 / $229.09	Professional		$64.57	$125.89	$229.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $50.12 / $87.10	Professional	26	$30.90	$50.12	$87.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $87.10 / $141.25	Professional	TC	$33.88	$87.10	$141.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $53.70 / $56.23	Facility	26	$43.65	$53.70	$56.23
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $56.23	Professional	26	$32.36	$45.71	$56.23
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $66.07 / $95.50	Professional	TC	$45.71	$66.07	$95.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $131.83 / $223.87	Professional		$52.48	$131.83	$223.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $28.18 / $77.62	Professional	26	$16.60	$28.18	$77.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $47.86 / $154.88	Professional	TC	$23.44	$47.86	$154.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $134.90 / $223.87	Professional		$91.20	$134.90	$223.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $53.70 / $85.11	Professional	26	$31.62	$53.70	$85.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $79.43 / $147.91	Professional	TC	$58.88	$79.43	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $218.78	Professional		$41.69	$69.18	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.18 / $83.18	Professional	26	$17.38	$28.18	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $40.74 / $134.90	Professional	TC	$23.99	$40.74	$134.90