Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.11 / $56.56 / $102.81	Professional		$40.11	$56.56	$102.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.61 / $33.79 / $69.66	Professional	26	$28.61	$33.79	$69.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.10 / $19.79 / $33.14	Professional	TC	$11.10	$19.79	$33.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.34 / $58.60 / $93.80	Professional		$24.34	$58.60	$93.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.07 / $41.52 / $61.70	Professional	26	$16.07	$41.52	$61.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $7.23 / $17.07 / $33.65	Professional	TC	$7.23	$17.07	$33.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.48 / $110.77 / $157.88	Professional		$53.48	$110.77	$157.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $34.97 / $72.45 / $103.28	Professional	26	$34.97	$72.45	$103.28
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $18.50 / $38.32 / $54.62	Professional	TC	$18.50	$38.32	$54.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $97.78 / $177.19	Professional		$89.13	$97.78	$177.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.18 / $67.00 / $115.65	Professional	26	$58.18	$67.00	$115.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $30.95 / $61.53	Professional	TC	$28.14	$30.95	$61.53
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.22 / $72.36 / $74.12	Facility	26	$44.22	$72.36	$74.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $40.85 / $62.70 / $82.89	Professional	26	$40.85	$62.70	$82.89
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $33.50 / $41.04	Professional	TC	$22.11	$33.50	$41.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.60 / $110.22 / $161.02	Professional		$58.60	$110.22	$161.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.42 / $41.52 / $63.51	Professional	26	$22.42	$41.52	$63.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $13.03 / $17.07 / $34.07	Professional	TC	$13.03	$17.07	$34.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $99.95 / $111.80 / $177.99	Professional		$99.95	$111.80	$177.99
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $65.23 / $74.31 / $116.17	Professional	26	$65.23	$74.31	$116.17
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $34.71 / $37.49 / $61.94	Professional	TC	$34.71	$37.49	$61.94
United Facility/Professional Professional Modifier Low / Median / High Price $34.64 / $59.42 / $176.01	Professional		$34.64	$59.42	$176.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.82 / $38.79 / $114.90	Professional	26	$23.82	$38.79	$114.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.82 / $18.04 / $61.11	Professional	TC	$10.82	$18.04	$61.11