Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.29 / $82.28 / $147.22	Professional		$58.29	$82.28	$147.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $41.74 / $82.15	Professional	26	$32.31	$41.74	$82.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.00 / $29.28 / $38.76	Professional	TC	$24.00	$29.28	$38.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.16 / $112.52 / $179.11	Professional		$64.16	$112.52	$179.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.44 / $68.89 / $105.16	Professional	26	$38.44	$68.89	$105.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.00 / $46.57 / $76.94	Professional	TC	$25.00	$46.57	$76.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $65.87 / $136.22 / $157.13	Professional		$65.87	$136.22	$157.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $36.75 / $78.08 / $87.66	Professional	26	$36.75	$78.08	$87.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $29.12 / $58.14 / $69.45	Professional	TC	$29.12	$58.14	$69.45
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $103.82 / $141.96	Professional		$70.20	$103.82	$141.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.49 / $58.18 / $81.09	Professional	26	$39.49	$58.18	$81.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.70 / $43.76 / $69.19	Professional	TC	$29.70	$43.76	$69.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $52.81 / $70.26 / $73.03	Facility	26	$52.81	$70.26	$73.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $63.80 / $76.84	Professional	26	$43.82	$63.80	$76.84
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $28.94 / $40.04 / $54.75	Professional	TC	$28.94	$40.04	$54.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $76.92 / $121.44 / $167.90	Professional		$76.92	$121.44	$167.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $68.89 / $105.16	Professional	26	$40.33	$68.89	$105.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.47 / $47.56 / $76.94	Professional	TC	$28.47	$47.56	$76.94
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.64 / $119.04 / $172.41	Professional		$72.64	$119.04	$172.41
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $41.72 / $68.38 / $100.26	Professional	26	$41.72	$68.38	$100.26
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $30.91 / $50.65 / $73.12	Professional	TC	$30.91	$50.65	$73.12
United Facility/Professional Professional Modifier Low / Median / High Price $64.59 / $100.65 / $194.77	Professional		$64.59	$100.65	$194.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.65 / $62.83 / $105.30	Professional	26	$40.65	$62.83	$105.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.38 / $41.75 / $73.70	Professional	TC	$27.38	$41.75	$73.70