Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $162.18	Professional		$51.29	$67.61	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $37.15 / $83.18	Professional	26	$28.18	$37.15	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $23.99 / $38.02	Professional	TC	$19.95	$23.99	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $100.00 / $173.78	Professional		$58.88	$100.00	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $60.26 / $102.33	Professional	26	$35.48	$60.26	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $43.65 / $77.62	Professional	TC	$23.99	$43.65	$77.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $138.04 / $165.96	Professional		$69.18	$138.04	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $77.62 / $91.20	Professional	26	$38.02	$77.62	$91.20
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $60.26 / $75.86	Professional	TC	$30.90	$60.26	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $107.15 / $151.36	Professional		$72.44	$107.15	$151.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $63.10 / $93.33	Professional	26	$40.74	$63.10	$93.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $46.77 / $69.18	Professional	TC	$25.70	$46.77	$69.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $72.44 / $72.44	Facility	26	$58.88	$72.44	$72.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $79.43	Professional	26	$48.98	$63.10	$79.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $41.69 / $54.95	Professional	TC	$30.90	$41.69	$54.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $123.03 / $173.78	Professional		$75.86	$123.03	$173.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $69.18 / $102.33	Professional	26	$42.66	$69.18	$102.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $48.98 / $77.62	Professional	TC	$28.84	$48.98	$77.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $125.89 / $169.82	Professional		$74.13	$125.89	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $97.72	Professional	26	$43.65	$72.44	$97.72
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $53.70 / $72.44	Professional	TC	$31.62	$53.70	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $97.72 / $162.18	Professional		$64.57	$97.72	$162.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $58.88 / $95.50	Professional	26	$38.90	$58.88	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $39.81 / $69.18	Professional	TC	$25.70	$39.81	$69.18