Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.78 / $58.81 / $126.64	Professional		$50.78	$58.81	$126.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $24.87 / $62.84	Professional	26	$19.48	$24.87	$62.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.86 / $43.36 / $80.18	Professional	TC	$30.86	$43.36	$80.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.43 / $77.18 / $120.17	Professional		$24.43	$77.18	$120.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $27.95 / $41.45	Professional	26	$12.30	$27.95	$41.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $11.77 / $49.23 / $84.43	Professional	TC	$11.77	$49.23	$84.43
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $79.63 / $164.94 / $235.10	Professional		$79.63	$164.94	$235.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $24.04 / $49.79 / $70.98	Professional	26	$24.04	$49.79	$70.98
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $55.59 / $115.14 / $164.12	Professional	TC	$55.59	$115.14	$164.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $133.44 / $265.25	Professional		$87.89	$133.44	$265.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.03 / $43.91 / $79.56	Professional	26	$40.03	$43.91	$79.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.56 / $93.41 / $185.68	Professional	TC	$45.56	$93.41	$185.68
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $30.55 / $48.10 / $50.32	Facility	26	$30.55	$48.10	$50.32
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.40 / $42.18 / $57.00	Professional	26	$32.40	$42.18	$57.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.61 / $65.79 / $101.91	Professional	TC	$42.61	$65.79	$101.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.18 / $143.36 / $215.78	Professional		$77.18	$143.36	$215.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.15 / $27.95 / $43.30	Professional	26	$15.15	$27.95	$43.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.83 / $49.23 / $96.49	Professional	TC	$22.83	$49.23	$96.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.06 / $142.91 / $255.25	Professional		$134.06	$142.91	$255.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.89 / $50.45 / $79.94	Professional	26	$44.89	$50.45	$79.94
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $89.18 / $93.87 / $171.68	Professional	TC	$89.18	$93.87	$171.68
United Facility/Professional Professional Modifier Low / Median / High Price $43.52 / $79.70 / $236.10	Professional		$43.52	$79.70	$236.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $26.70 / $79.06	Professional	26	$16.23	$26.70	$79.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.28 / $45.47 / $157.04	Professional	TC	$27.28	$45.47	$157.04