Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.20 / $43.61 / $98.37	Professional		$38.20	$43.61	$98.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.38 / $29.77 / $189.54	Professional	26	$23.38	$29.77	$189.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.11 / $17.00 / $38.60	Professional	TC	$10.11	$17.00	$38.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.43 / $39.43 / $39.43	Facility		$39.43	$39.43	$39.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.68 / $56.17 / $80.92	Professional		$19.68	$56.17	$80.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.57 / $33.50 / $50.19	Professional	26	$14.57	$33.50	$50.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $4.26 / $22.67 / $38.36	Professional	TC	$4.26	$22.67	$38.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $52.35 / $108.43 / $154.56	Professional		$52.35	$108.43	$154.56
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $28.54 / $59.12 / $84.26	Professional	26	$28.54	$59.12	$84.26
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $23.81 / $49.32 / $70.30	Professional	TC	$23.81	$49.32	$70.30
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $36.57 / $61.68 / $127.82	Facility		$36.57	$61.68	$127.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.41 / $87.53 / $174.00	Professional		$64.41	$87.53	$174.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $52.93 / $94.43	Professional	26	$47.50	$52.93	$94.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.75 / $40.03 / $79.56	Professional	TC	$16.75	$40.03	$79.56
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $61.91 / $99.83 / $109.21	Facility		$61.91	$99.83	$109.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $36.58 / $57.48 / $60.30	Facility	26	$36.58	$57.48	$60.30
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.38 / $50.46 / $66.59	Professional	26	$35.38	$50.46	$66.59
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $14.85 / $20.65 / $45.82	Professional	TC	$14.85	$20.65	$45.82
Providence Facility/Professional Facility Modifier Low / Median / High Price $47.93 / $123.13 / $158.11	Facility		$47.93	$123.13	$158.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.17 / $105.19 / $158.11	Professional		$56.17	$105.19	$158.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.98 / $33.50 / $51.97	Professional	26	$17.98	$33.50	$51.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $8.65 / $22.67 / $43.84	Professional	TC	$8.65	$22.67	$43.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.56 / $108.20 / $174.08	Professional		$97.56	$108.20	$174.08
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $53.27 / $60.67 / $94.86	Professional	26	$53.27	$60.67	$94.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $44.29 / $47.04 / $80.09	Professional	TC	$44.29	$47.04	$80.09
United Facility/Professional Professional Modifier Low / Median / High Price $33.35 / $58.00 / $171.81	Professional		$33.35	$58.00	$171.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.48 / $19.48 / $64.95	Professional	26	$19.48	$19.48	$64.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.86 / $14.98 / $78.00	Professional	TC	$13.86	$14.98	$78.00