Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.84 / $91.66 / $170.59	Professional		$64.84	$91.66	$170.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.28 / $55.52 / $114.68	Professional	26	$47.28	$55.52	$114.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $34.72 / $55.91	Professional	TC	$17.38	$34.72	$55.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.54 / $94.47 / $154.55	Professional		$42.54	$94.47	$154.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $68.00 / $102.54	Professional	26	$29.80	$68.00	$102.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.01 / $26.46 / $53.81	Professional	TC	$12.01	$26.46	$53.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.28 / $180.78 / $257.69	Professional		$87.28	$180.78	$257.69
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $57.41 / $118.91 / $169.50	Professional	26	$57.41	$118.91	$169.50
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.87 / $61.87 / $88.19	Professional	TC	$29.87	$61.87	$88.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $162.81 / $289.66	Professional		$145.22	$162.81	$289.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.54 / $115.91 / $189.91	Professional	26	$95.54	$115.91	$189.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.90 / $51.35 / $99.74	Professional	TC	$46.90	$51.35	$99.74
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.63 / $118.92 / $121.27	Facility	26	$89.63	$118.92	$121.27
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.19 / $118.40 / $150.81	Professional	26	$83.19	$118.40	$150.81
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.83 / $54.27 / $76.94	Professional	TC	$45.83	$54.27	$76.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $94.47 / $182.16 / $265.77	Professional		$94.47	$182.16	$265.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.56 / $68.00 / $104.51	Professional	26	$36.56	$68.00	$104.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $21.52 / $29.52 / $56.17	Professional	TC	$21.52	$29.52	$56.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.19 / $188.15 / $294.16	Professional		$165.19	$188.15	$294.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $107.73 / $122.02 / $191.84	Professional	26	$107.73	$122.02	$191.84
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $57.46 / $64.65 / $102.53	Professional	TC	$57.46	$64.65	$102.53
United Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $65.76 / $290.91	Professional		$55.22	$65.76	$290.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.19 / $64.05 / $189.73	Professional	26	$39.19	$64.05	$189.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $40.07 / $101.18	Professional	TC	$16.03	$40.07	$101.18