Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.45 / $102.45 / $113.25	Facility	26	$102.45	$102.45	$113.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.11 / $100.56 / $217.16	Professional		$93.11	$100.56	$217.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.74 / $54.82 / $114.73	Professional	TC	$49.74	$54.82	$114.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.06 / $52.06 / $52.06	Facility	26	$52.06	$52.06	$52.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.76 / $204.02 / $280.12	Professional		$115.76	$204.02	$280.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.49 / $105.30 / $150.56	Professional	TC	$57.49	$105.30	$150.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $158.62 / $206.82 / $237.04	Professional		$158.62	$206.82	$237.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $102.57 / $115.48	Professional	26	$78.86	$102.57	$115.48
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $79.76 / $103.58 / $121.58	Professional	TC	$79.76	$103.58	$121.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $117.74 / $164.92 / $278.97	Professional		$117.74	$164.92	$278.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.90 / $79.00 / $140.06	Professional	TC	$42.90	$79.00	$140.06
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.62 / $88.50 / $93.80	Facility	26	$67.62	$88.50	$93.80
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $59.34 / $79.87 / $106.58	Professional	TC	$59.34	$79.87	$106.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $52.06 / $52.06 / $52.06	Facility	26	$52.06	$52.06	$52.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $129.93 / $208.21 / $271.66	Professional		$129.93	$208.21	$271.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.44 / $108.34 / $157.93	Professional	TC	$58.44	$108.34	$157.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $354.01 / $354.01 / $354.01	Facility	26	$354.01	$354.01	$354.01
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $156.06 / $196.80 / $273.83	Professional		$156.06	$196.80	$273.83
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $80.73 / $108.79 / $145.91	Professional	TC	$80.73	$108.79	$145.91
United Facility/Professional Professional Modifier Low / Median / High Price $128.34 / $195.30 / $299.39	Professional		$128.34	$195.30	$299.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $76.15 / $112.71 / $159.52	Professional	TC	$76.15	$112.71	$159.52