Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $67.61 / $131.83	Professional		$52.48	$67.61	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $22.91 / $42.66	Professional	26	$19.05	$22.91	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $89.13	Professional	TC	$31.62	$44.67	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $74.13 / $123.03	Professional		$29.51	$74.13	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $20.89 / $40.74	Professional	26	$12.30	$20.89	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $53.70 / $87.10	Professional	TC	$17.78	$53.70	$87.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $165.96 / $234.42	Professional		$83.18	$165.96	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $47.86 / $67.61	Professional	26	$23.99	$47.86	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $117.49 / $165.96	Professional	TC	$58.88	$117.49	$165.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $128.82 / $251.19	Professional		$81.28	$128.82	$251.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $81.28	Professional	26	$35.48	$44.67	$81.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $97.72 / $169.82	Professional	TC	$41.69	$97.72	$169.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $46.77 / $48.98	Facility	26	$35.48	$46.77	$48.98
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $36.31 / $54.95	Professional	26	$32.36	$36.31	$54.95
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $57.54 / $112.20	Professional	TC	$43.65	$57.54	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $131.83 / $245.47	Professional		$54.95	$131.83	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.70 / $70.79	Professional	26	$14.45	$25.70	$70.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $53.70 / $173.78	Professional	TC	$20.89	$53.70	$173.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $144.54 / $245.47	Professional		$97.72	$144.54	$245.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $50.12 / $77.62	Professional	26	$28.84	$50.12	$77.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $97.72 / $169.82	Professional	TC	$67.61	$97.72	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $239.88	Professional		$41.69	$69.18	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $26.30 / $77.62	Professional	26	$15.49	$26.30	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $162.18	Professional	TC	$25.70	$43.65	$162.18