Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $204.17 / $234.42	Facility	26	$128.82	$204.17	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $371.54	Professional		$109.65	$169.82	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $61.66 / $147.91	Professional	TC	$38.90	$61.66	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $426.58	Professional		$204.17	$309.03	$426.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $117.49 / $158.49	Professional	TC	$79.43	$117.49	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $331.13 / $389.05	Professional		$151.36	$331.13	$389.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $208.93 / $239.88	Professional	26	$93.33	$208.93	$239.88
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $123.03 / $151.36	Professional	TC	$58.88	$123.03	$151.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $281.84 / $467.74	Professional		$218.78	$281.84	$467.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $169.82	Professional	TC	$87.10	$125.89	$169.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $181.97 / $186.21	Facility	26	$151.36	$181.97	$186.21
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Professional		$95.50	$95.50	$95.50
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $87.10 / $107.15	Professional	TC	$56.23	$87.10	$107.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $316.23 / $416.87	Professional		$223.87	$316.23	$416.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $109.65 / $154.88	Professional	TC	$75.86	$109.65	$154.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $812.83 / $812.83 / $812.83	Facility	26	$812.83	$812.83	$812.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $309.03 / $398.11	Professional		$257.04	$309.03	$398.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $107.15 / $141.25	Professional	TC	$93.33	$107.15	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $165.96 / $416.87	Professional		$123.03	$165.96	$416.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $64.57 / $144.54	Professional	TC	$41.69	$64.57	$144.54