Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.97 / $66.00 / $80.70	Professional		$41.97	$66.00	$80.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.29 / $22.91 / $32.99	Professional	26	$18.29	$22.91	$32.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.68 / $38.25 / $57.97	Professional	TC	$23.68	$38.25	$57.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.04 / $92.99 / $133.19	Professional		$48.04	$92.99	$133.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.74 / $39.59 / $59.24	Professional	26	$21.74	$39.59	$59.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.41 / $52.83 / $77.17	Professional	TC	$26.41	$52.83	$77.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $48.52 / $99.60 / $115.74	Professional		$48.52	$99.60	$115.74
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $20.46 / $43.60 / $48.81	Professional	26	$20.46	$43.60	$48.81
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $28.05 / $56.02 / $66.91	Professional	TC	$28.05	$56.02	$66.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.44 / $78.30 / $118.95	Professional		$53.44	$78.30	$118.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.10 / $32.64 / $53.27	Professional	26	$22.10	$32.64	$53.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.62 / $43.44 / $67.13	Professional	TC	$28.62	$43.44	$67.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.89 / $40.44 / $43.38	Facility	26	$29.89	$40.44	$43.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $24.66 / $37.02 / $45.57	Professional	26	$24.66	$37.02	$45.57
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $30.15 / $48.10 / $76.38	Professional	TC	$30.15	$48.10	$76.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.40 / $90.17 / $128.13	Professional		$59.40	$90.17	$128.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.89 / $40.47 / $59.24	Professional	26	$22.89	$40.47	$59.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.87 / $56.00 / $77.17	Professional	TC	$28.87	$56.00	$77.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $88.01 / $128.58	Professional		$53.70	$88.01	$128.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $38.63 / $57.16	Professional	26	$23.57	$38.63	$57.16
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $30.13 / $49.39 / $72.15	Professional	TC	$30.13	$49.39	$72.15
United Facility/Professional Professional Modifier Low / Median / High Price $56.42 / $79.65 / $131.85	Professional		$56.42	$79.65	$131.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.79 / $35.96 / $60.01	Professional	26	$23.79	$35.96	$60.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.54 / $75.01	Professional	TC	$31.62	$44.54	$75.01