Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.76 / $64.43 / $120.61	Professional		$48.76	$64.43	$120.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.71 / $25.47 / $51.09	Professional	26	$20.71	$25.47	$51.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.46 / $38.97 / $69.52	Professional	TC	$30.46	$38.97	$69.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.20 / $77.08 / $113.75	Professional		$26.20	$77.08	$113.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.60 / $30.51 / $46.77	Professional	26	$13.60	$30.51	$46.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.64 / $46.57 / $75.17	Professional	TC	$12.64	$46.57	$75.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $76.47 / $158.38 / $225.77	Professional		$76.47	$158.38	$225.77
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $53.81 / $76.70	Professional	26	$25.98	$53.81	$76.70
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $50.49 / $104.58 / $149.07	Professional	TC	$50.49	$104.58	$149.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $128.09 / $254.63	Professional		$81.59	$128.09	$254.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.23 / $49.80 / $85.94	Professional	26	$43.23	$49.80	$85.94
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.91 / $84.86 / $168.69	Professional	TC	$48.91	$84.86	$168.69
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.77 / $52.43 / $54.94	Facility	26	$33.77	$52.43	$54.94
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $50.65 / $63.29	Professional	26	$32.96	$50.65	$63.29
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $50.25 / $71.29 / $98.49	Professional	TC	$50.25	$71.29	$98.49
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.08 / $133.96 / $202.42	Professional		$77.08	$133.96	$202.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.77 / $30.51 / $47.06	Professional	26	$16.77	$30.51	$47.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.50 / $46.57 / $85.91	Professional	TC	$23.50	$46.57	$85.91
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $123.29 / $134.06 / $237.35	Professional		$123.29	$134.06	$237.35
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.28 / $53.85 / $85.44	Professional	26	$47.28	$53.85	$85.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $76.01 / $80.30 / $146.33	Professional	TC	$76.01	$80.30	$146.33
United Facility/Professional Professional Modifier Low / Median / High Price $41.79 / $69.65 / $217.13	Professional		$41.79	$69.65	$217.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.54 / $28.11 / $83.26	Professional	26	$17.54	$28.11	$83.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.25 / $40.42 / $133.87	Professional	TC	$24.25	$40.42	$133.87