Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.37 / $60.52 / $81.26	Professional		$49.37	$60.52	$81.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.89 / $10.25 / $14.12	Professional	26	$7.89	$10.25	$14.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.48 / $51.02 / $67.14	Professional	TC	$41.48	$51.02	$67.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $87.88 / $151.19	Professional		$44.20	$87.88	$151.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $14.49 / $22.95	Professional	26	$8.11	$14.49	$22.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.75 / $75.19 / $127.20	Professional	TC	$39.75	$75.19	$127.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $57.39 / $115.39 / $132.34	Professional		$57.39	$115.39	$132.34
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $8.65 / $18.39 / $19.95	Professional	26	$8.65	$18.39	$19.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $48.74 / $97.00 / $112.39	Professional	TC	$48.74	$97.00	$112.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $65.90 / $89.40 / $121.26	Professional		$65.90	$89.40	$121.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.53 / $14.72 / $26.43	Professional	26	$12.53	$14.72	$26.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.63 / $75.33 / $137.25	Professional	TC	$49.63	$75.33	$137.25
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $11.20 / $16.57 / $18.09	Facility	26	$11.20	$16.57	$18.09
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $11.18 / $15.38 / $18.63	Professional	26	$11.18	$15.38	$18.63
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $52.65 / $67.93 / $91.77	Professional	TC	$52.65	$67.93	$91.77
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.67 / $9.67 / $9.67	Facility	26	$9.67	$9.67	$9.67
Providence Facility/Professional Professional Modifier Low / Median / High Price $81.06 / $104.33 / $140.07	Professional		$81.06	$104.33	$140.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.05 / $15.34 / $22.95	Professional	26	$9.05	$15.34	$22.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.26 / $79.50 / $127.20	Professional	TC	$42.26	$79.50	$127.20
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $73.45 / $107.31 / $143.47	Professional		$73.45	$107.31	$143.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.01 / $17.32 / $23.91	Professional	26	$12.01	$17.32	$23.91
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $61.82 / $89.98 / $119.56	Professional	TC	$61.82	$89.98	$119.56
United Facility/Professional Professional Modifier Low / Median / High Price $62.63 / $89.39 / $142.11	Professional		$62.63	$89.39	$142.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $15.12 / $25.25	Professional	26	$9.88	$15.12	$25.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.36 / $71.34 / $121.03	Professional	TC	$47.36	$71.34	$121.03