Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $63.10 / $112.20	Professional		$53.70	$63.10	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $21.88 / $44.67	Professional	26	$18.20	$21.88	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $40.74 / $67.61	Professional	TC	$33.88	$40.74	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $57.54 / $102.33	Professional		$30.20	$57.54	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $20.89 / $36.31	Professional	26	$10.72	$20.89	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $37.15 / $66.07	Professional	TC	$19.05	$37.15	$66.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $125.89 / $181.97	Professional		$63.10	$125.89	$181.97
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $47.86 / $67.61	Professional	26	$23.44	$47.86	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $79.43 / $114.82	Professional	TC	$39.81	$79.43	$114.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $223.87	Professional		$95.50	$128.82	$223.87
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $42.66 / $81.28	Professional	26	$35.48	$42.66	$81.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $72.44 / $144.54	Professional	TC	$58.88	$72.44	$144.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $48.98 / $53.70	Facility	26	$39.81	$48.98	$53.70
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $39.81 / $53.70	Professional	26	$32.36	$39.81	$53.70
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $81.28 / $97.72	Professional	TC	$63.10	$81.28	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $128.82 / $204.17	Professional		$57.54	$128.82	$204.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.70 / $70.79	Professional	26	$14.45	$25.70	$70.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $47.86 / $120.23	Professional	TC	$24.55	$47.86	$120.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $138.04 / $218.78	Professional		$81.28	$138.04	$218.78
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $50.12 / $77.62	Professional	26	$28.84	$50.12	$77.62
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $87.10 / $138.04	Professional	TC	$51.29	$87.10	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $72.44 / $213.80	Professional		$40.74	$72.44	$213.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $25.70 / $77.62	Professional	26	$14.45	$25.70	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $46.77 / $138.04	Professional	TC	$25.70	$46.77	$138.04