Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.00 / $49.48 / $99.20	Professional		$44.00	$49.48	$99.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.23 / $35.92 / $98.16	Professional	26	$27.23	$35.92	$98.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.96 / $21.35 / $33.42	Professional	TC	$16.96	$21.35	$33.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.58 / $60.84 / $89.51	Professional		$24.58	$60.84	$89.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.14 / $38.93 / $56.39	Professional	26	$16.14	$38.93	$56.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.13 / $21.91 / $37.96	Professional	TC	$9.13	$21.91	$37.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.99 / $111.83 / $159.40	Professional		$53.99	$111.83	$159.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $68.45 / $97.58	Professional	26	$33.04	$68.45	$97.58
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $20.94 / $43.37 / $61.82	Professional	TC	$20.94	$43.37	$61.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $75.67 / $97.15 / $179.32	Professional		$75.67	$97.15	$179.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.73 / $57.62 / $109.29	Professional	26	$50.73	$57.62	$109.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.81 / $37.79 / $70.03	Professional	TC	$31.81	$37.79	$70.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $42.61 / $66.61 / $70.04	Facility	26	$42.61	$66.61	$70.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $42.40 / $58.08 / $71.02	Professional	26	$42.40	$58.08	$71.02
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $23.20 / $32.46 / $43.71	Professional	TC	$23.20	$32.46	$43.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.84 / $106.84 / $158.60	Professional		$60.84	$106.84	$158.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.01 / $38.93 / $60.06	Professional	26	$21.01	$38.93	$60.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $11.11 / $21.91 / $38.70	Professional	TC	$11.11	$21.91	$38.70
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $98.75 / $109.07 / $178.36	Professional		$98.75	$109.07	$178.36
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.65 / $70.22 / $109.78	Professional	26	$61.65	$70.22	$109.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $39.06 / $69.42	Professional	TC	$37.11	$39.06	$69.42
United Facility/Professional Professional Modifier Low / Median / High Price $34.21 / $57.02 / $173.90	Professional		$34.21	$57.02	$173.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.52 / $22.52 / $108.55	Professional	26	$22.52	$22.52	$108.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.69 / $12.98 / $38.97	Professional	TC	$11.69	$12.98	$38.97