Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.64 / $56.92 / $114.94	Facility	26	$49.64	$56.92	$114.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.66 / $148.08 / $387.28	Professional		$93.66	$148.08	$387.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.93 / $124.30 / $328.90	Professional	TC	$78.93	$124.30	$328.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $26.26 / $26.26	Facility	26	$26.26	$26.26	$26.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.45 / $240.72 / $395.28	Professional		$117.45	$240.72	$395.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.28 / $200.85 / $333.40	Professional	TC	$96.28	$200.85	$333.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.01 / $327.73 / $381.16	Professional		$275.01	$327.73	$381.16
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $44.23 / $52.85 / $59.51	Professional	26	$44.23	$52.85	$59.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $229.44 / $273.95 / $321.64	Professional	TC	$229.44	$273.95	$321.64
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $176.70 / $236.04 / $428.56	Professional		$176.70	$236.04	$428.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.44 / $230.88 / $362.94	Professional	TC	$154.44	$230.88	$362.94
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $33.92 / $45.56 / $46.90	Facility	26	$33.92	$45.56	$46.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.30 / $140.29 / $155.88	Professional		$117.30	$140.29	$155.88
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $108.07 / $155.44 / $239.21	Professional	TC	$108.07	$155.44	$239.21
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $26.26 / $26.26	Facility	26	$26.26	$26.26	$26.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $187.03 / $286.06 / $405.65	Professional		$187.03	$286.06	$405.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.18 / $230.29 / $335.69	Professional	TC	$128.18	$230.29	$335.69
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $851.78 / $851.78 / $851.78	Facility	26	$851.78	$851.78	$851.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $207.26 / $288.79 / $389.47	Professional		$207.26	$288.79	$389.47
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $165.86 / $241.61 / $327.44	Professional	TC	$165.86	$241.61	$327.44
United Facility/Professional Professional Modifier Low / Median / High Price $108.85 / $159.86 / $378.30	Professional		$108.85	$159.86	$378.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.06 / $126.81 / $311.22	Professional	TC	$85.06	$126.81	$311.22