Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.69 / $63.66 / $124.64	Professional		$54.69	$63.66	$124.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $22.57 / $48.30	Professional	26	$18.98	$22.57	$48.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.59 / $38.74 / $76.34	Professional	TC	$34.59	$38.74	$76.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.09 / $80.79 / $101.72	Professional		$29.09	$80.79	$101.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.32 / $29.34 / $36.47	Professional	26	$10.32	$29.34	$36.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $51.34 / $66.63	Professional	TC	$18.32	$51.34	$66.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $62.98 / $130.44 / $185.94	Professional		$62.98	$130.44	$185.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.55 / $48.78 / $69.53	Professional	26	$23.55	$48.78	$69.53
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.44 / $81.69 / $116.44	Professional	TC	$39.44	$81.69	$116.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $94.94 / $133.16 / $209.00	Professional		$94.94	$133.16	$209.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.18 / $42.73 / $77.44	Professional	26	$35.18	$42.73	$77.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.76 / $72.59 / $131.56	Professional	TC	$59.76	$72.59	$131.56
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $48.77 / $51.59	Facility	26	$32.15	$48.77	$51.59
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $40.79 / $55.35	Professional	26	$32.11	$40.79	$55.35
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $57.49 / $78.79 / $99.63	Professional	TC	$57.49	$78.79	$99.63
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.14 / $133.76 / $196.91	Professional		$80.14	$133.76	$196.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.92 / $29.34 / $40.10	Professional	26	$11.92	$29.34	$40.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $22.22 / $54.26 / $68.92	Professional	TC	$22.22	$54.26	$68.92
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $122.09 / $143.16 / $217.42	Professional		$122.09	$143.16	$217.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.69 / $51.13 / $77.95	Professional	26	$43.69	$51.13	$77.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $78.40 / $92.03 / $139.62	Professional	TC	$78.40	$92.03	$139.62
United Facility/Professional Professional Modifier Low / Median / High Price $45.04 / $72.59 / $215.02	Professional		$45.04	$72.59	$215.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $36.15 / $81.04	Professional	26	$16.67	$36.15	$81.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $46.61 / $144.94	Professional	TC	$28.37	$46.61	$144.94