Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $51.29 / $70.79	Professional		$38.02	$51.29	$70.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.95 / $26.92	Professional	26	$15.85	$19.95	$26.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $25.12 / $50.12	Professional	TC	$19.95	$25.12	$50.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $81.28 / $131.83	Professional		$47.86	$81.28	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $33.88 / $57.54	Professional	26	$20.42	$33.88	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $47.86 / $75.86	Professional	TC	$25.70	$47.86	$75.86
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $102.33 / $123.03	Professional		$51.29	$102.33	$123.03
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $43.65 / $51.29	Professional	26	$21.38	$43.65	$51.29
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $72.44	Professional	TC	$30.20	$57.54	$72.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $83.18 / $120.23	Professional		$56.23	$83.18	$120.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $34.67 / $52.48	Professional	26	$22.91	$34.67	$52.48
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $47.86 / $67.61	Professional	TC	$30.20	$47.86	$67.61
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $40.74 / $41.69	Facility	26	$33.88	$40.74	$41.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $37.15 / $44.67	Professional	26	$28.18	$37.15	$44.67
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $48.98 / $69.18	Professional	TC	$34.67	$48.98	$69.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $89.13 / $128.82	Professional		$58.88	$89.13	$128.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $41.69 / $57.54	Professional	26	$23.99	$41.69	$57.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $58.88 / $79.43	Professional	TC	$30.90	$58.88	$79.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $93.33 / $125.89	Professional		$54.95	$93.33	$125.89
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $40.74 / $54.95	Professional	26	$24.55	$40.74	$54.95
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $52.48 / $70.79	Professional	TC	$30.90	$52.48	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $77.62 / $125.89	Professional		$47.86	$77.62	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $54.95	Professional	26	$21.88	$34.67	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $42.66 / $74.13	Professional	TC	$26.30	$42.66	$74.13