Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.45 / $68.44 / $138.40	Facility	26	$61.45	$68.44	$138.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.93 / $112.86 / $223.84	Professional		$59.93	$112.86	$223.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.84 / $80.59 / $155.37	Professional	TC	$40.84	$80.59	$155.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $31.62	Facility	26	$31.62	$31.62	$31.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.35 / $179.02 / $263.77	Professional		$118.35	$179.02	$263.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.56 / $126.92 / $182.91	Professional	TC	$80.56	$126.92	$182.91
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.80 / $206.37 / $238.41	Professional		$173.80	$206.37	$238.41
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.41 / $62.63 / $70.51	Professional	26	$52.41	$62.63	$70.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $119.76 / $143.00 / $167.90	Professional	TC	$119.76	$143.00	$167.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $140.88 / $163.95 / $274.50	Professional		$140.88	$163.95	$274.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.14 / $131.96 / $189.09	Professional	TC	$97.14	$131.96	$189.09
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $44.10 / $54.03 / $60.30	Facility	26	$44.10	$54.03	$60.30
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $75.17 / $113.23 / $154.69	Professional	TC	$75.17	$113.23	$154.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $31.62	Facility	26	$31.62	$31.62	$31.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $153.40 / $206.70 / $262.26	Professional		$153.40	$206.70	$262.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.26 / $130.77 / $182.91	Professional	TC	$84.26	$130.77	$182.91
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $385.75 / $385.75 / $385.75	Facility	26	$385.75	$385.75	$385.75
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $161.60 / $199.91 / $255.83	Professional		$161.60	$199.91	$255.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $111.32 / $137.71 / $176.24	Professional	TC	$111.32	$137.71	$176.24
United Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $114.87 / $281.61	Professional		$93.43	$114.87	$281.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.73 / $86.92 / $197.88	Professional	TC	$60.73	$86.92	$197.88