Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.98 / $61.80 / $127.95	Professional		$46.98	$61.80	$127.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.73 / $22.39 / $47.04	Professional	26	$18.73	$22.39	$47.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.24 / $42.36 / $84.32	Professional	TC	$28.24	$42.36	$84.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.35 / $69.97 / $122.74	Professional		$26.35	$69.97	$122.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.26 / $26.81 / $40.82	Professional	26	$12.26	$26.81	$40.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.04 / $43.16 / $87.51	Professional	TC	$14.04	$43.16	$87.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $80.27 / $166.26 / $236.99	Professional		$80.27	$166.26	$236.99
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.72 / $49.13 / $70.03	Professional	26	$23.72	$49.13	$70.03
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $56.55 / $117.13 / $166.96	Professional	TC	$56.55	$117.13	$166.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.66 / $134.49 / $267.35	Professional		$83.66	$134.49	$267.35
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.50 / $44.40 / $78.52	Professional	26	$39.50	$44.40	$78.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.40 / $95.01 / $188.86	Professional	TC	$50.40	$95.01	$188.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.35 / $44.85 / $48.91	Facility	26	$29.35	$44.85	$48.91
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.50 / $46.46 / $57.87	Professional	26	$35.50	$46.46	$57.87
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $46.50 / $63.84 / $95.12	Professional	TC	$46.50	$63.84	$95.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.31 / $146.56 / $221.94	Professional		$75.31	$146.56	$221.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.55 / $26.81 / $42.15	Professional	26	$14.55	$26.81	$42.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.80 / $43.16 / $100.01	Professional	TC	$19.80	$43.16	$100.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $137.06 / $144.27 / $260.58	Professional		$137.06	$144.27	$260.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.29 / $49.76 / $78.87	Professional	26	$44.29	$49.76	$78.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $90.67 / $97.65 / $178.59	Professional	TC	$90.67	$97.65	$178.59
United Facility/Professional Professional Modifier Low / Median / High Price $41.79 / $48.73 / $139.30	Professional		$41.79	$48.73	$139.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.81 / $26.33 / $78.01	Professional	26	$15.81	$26.33	$78.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $34.15 / $163.35	Professional	TC	$25.98	$34.15	$163.35