Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.47 / $98.58 / $199.44	Facility	26	$84.47	$98.58	$199.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.64 / $138.69 / $293.89	Professional		$71.64	$138.69	$293.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.35 / $97.42 / $191.31	Professional	TC	$46.35	$97.42	$191.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.24 / $212.49 / $303.00	Professional		$138.24	$212.49	$303.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.70 / $137.63 / $205.53	Professional	TC	$78.70	$137.63	$205.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.68 / $238.63 / $292.11	Professional		$213.68	$238.63	$292.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $76.14 / $87.65 / $102.55	Professional	26	$76.14	$87.65	$102.55
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $135.19 / $153.47 / $189.55	Professional	TC	$135.19	$153.47	$189.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $159.00 / $214.50 / $334.47	Professional		$159.00	$214.50	$334.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.41 / $155.83 / $217.50	Professional	TC	$109.41	$155.83	$217.50
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $58.31 / $77.72 / $79.06	Facility	26	$58.31	$77.72	$79.06
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $69.95 / $116.58 / $170.96	Professional	TC	$69.95	$116.58	$170.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.60 / $237.80 / $311.60	Professional		$158.60	$237.80	$311.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $78.70 / $142.63 / $205.53	Professional	TC	$78.70	$142.63	$205.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,298.07 / $2,298.07 / $2,298.07	Facility	26	$2,298.07	$2,298.07	$2,298.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.56 / $232.04 / $299.32	Professional		$194.56	$232.04	$299.32
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $115.12 / $154.24 / $192.45	Professional	TC	$115.12	$154.24	$192.45
United Facility/Professional Professional Modifier Low / Median / High Price $93.67 / $147.15 / $299.75	Professional		$93.67	$147.15	$299.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $51.32 / $96.05 / $186.23	Professional	TC	$51.32	$96.05	$186.23