Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $53.70 / $117.49	Professional		$42.66	$53.70	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $50.12 / $147.91	Professional	26	$26.92	$50.12	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $19.95 / $40.74	Professional	TC	$15.14	$19.95	$40.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $48.98 / $89.13	Professional		$25.12	$48.98	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $29.51 / $56.23	Professional	26	$16.22	$29.51	$56.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.33 / $19.95 / $38.02	Professional	TC	$9.33	$19.95	$38.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $109.65 / $154.88	Professional		$53.70	$109.65	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $66.07 / $93.33	Professional	26	$33.11	$66.07	$93.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $42.66 / $60.26	Professional	TC	$21.38	$42.66	$60.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $97.72 / $177.83	Professional		$58.88	$97.72	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $57.54 / $112.20	Professional	26	$35.48	$57.54	$112.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $37.15 / $67.61	Professional	TC	$20.42	$37.15	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $67.61 / $70.79	Facility	26	$53.70	$67.61	$70.79
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $69.18	Professional	26	$40.74	$53.70	$69.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $43.65	Professional	TC	$22.91	$33.88	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $104.71 / $165.96	Professional		$45.71	$104.71	$165.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $36.31 / $100.00	Professional	26	$20.89	$36.31	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $22.39 / $63.10	Professional	TC	$11.22	$22.39	$63.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $107.15 / $177.83	Professional		$66.07	$107.15	$177.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $69.18 / $109.65	Professional	26	$40.74	$69.18	$109.65
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $66.07	Professional	TC	$25.70	$38.90	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $57.54 / $173.78	Professional		$33.88	$57.54	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $36.31 / $109.65	Professional	26	$21.88	$36.31	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.75 / $19.50 / $66.07	Professional	TC	$11.75	$19.50	$66.07