Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $144.54	Professional		$51.29	$67.61	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $27.54 / $75.86	Professional	26	$20.89	$27.54	$75.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $63.10	Professional	TC	$28.18	$34.67	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $107.15 / $173.78	Professional		$61.66	$107.15	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $74.13	Professional	26	$25.70	$43.65	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $64.57 / $104.71	Professional	TC	$35.48	$64.57	$104.71
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 $27.54 / $56.23 / $67.61	Professional	26	$27.54	$56.23	$67.61
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $79.43 / $100.00	Professional	TC	$41.69	$79.43	$100.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $83.18 / $158.49	Facility		$57.54	$83.18	$158.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $109.65 / $158.49	Professional		$70.79	$109.65	$158.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $43.65 / $64.57	Professional	26	$29.51	$43.65	$64.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $64.57 / $91.20	Professional	TC	$40.74	$64.57	$91.20
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $123.03 / $125.89	Facility		$104.71	$123.03	$125.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $52.48	Facility	26	$43.65	$52.48	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $57.54	Professional	26	$32.36	$45.71	$57.54
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $66.07 / $89.13	Professional	TC	$42.66	$66.07	$89.13
Providence Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $83.18 / $144.54	Facility		$57.54	$83.18	$144.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $169.82	Professional		$79.43	$120.23	$169.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $50.12 / $74.13	Professional	26	$30.90	$50.12	$74.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $77.62 / $104.71	Professional	TC	$42.66	$77.62	$104.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $123.03 / $169.82	Professional		$72.44	$123.03	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $52.48 / $70.79	Professional	26	$31.62	$52.48	$70.79
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $70.79 / $100.00	Professional	TC	$42.66	$70.79	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $102.33 / $165.96	Professional		$64.57	$102.33	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $43.65 / $70.79	Professional	26	$28.18	$43.65	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $58.88 / $95.50	Professional	TC	$36.31	$58.88	$95.50