Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $57.54 / $102.33	Professional		$43.65	$57.54	$102.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $33.88 / $75.86	Professional	26	$28.84	$33.88	$75.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $20.89 / $36.31	Professional	TC	$15.14	$20.89	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $48.98 / $93.33	Professional		$24.55	$48.98	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $30.90 / $61.66	Professional	26	$16.98	$30.90	$61.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $8.13 / $17.78 / $33.88	Professional	TC	$8.13	$17.78	$33.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $107.15 / $154.88	Professional		$53.70	$107.15	$154.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $70.79 / $100.00	Professional	26	$34.67	$70.79	$100.00
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $37.15 / $53.70	Professional	TC	$18.62	$37.15	$53.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $97.72 / $177.83	Professional		$72.44	$97.72	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $64.57 / $120.23	Professional	26	$38.02	$64.57	$120.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $64.57	Professional	TC	$22.91	$30.90	$64.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $72.44 / $75.86	Facility	26	$58.88	$72.44	$75.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $63.10 / $87.10	Professional	26	$44.67	$63.10	$87.10
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $32.36 / $46.77	Professional	TC	$24.55	$32.36	$46.77
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $107.15 / $165.96	Professional		$44.67	$107.15	$165.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $38.02 / $104.71	Professional	26	$22.39	$38.02	$104.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $20.89 / $56.23	Professional	TC	$12.88	$20.89	$56.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $112.20 / $177.83	Professional		$66.07	$112.20	$177.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $74.13 / $114.82	Professional	26	$42.66	$74.13	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $36.31 / $61.66	Professional	TC	$22.91	$36.31	$61.66
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $57.54 / $177.83	Professional		$33.11	$57.54	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $38.90 / $114.82	Professional	26	$21.88	$38.90	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $18.20 / $61.66	Professional	TC	$10.72	$18.20	$61.66