Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $63.10 / $67.61	Facility	26	$33.88	$63.10	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $162.18 / $323.59	Professional		$128.82	$162.18	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $138.04 / $275.42	Professional	TC	$102.33	$138.04	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $524.81	Professional		$162.18	$309.03	$524.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $269.15 / $446.68	Professional	TC	$128.82	$269.15	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $380.19 / $478.63	Professional		$302.00	$380.19	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $69.18	Professional	26	$47.86	$58.88	$69.18
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $323.59 / $407.38	Professional	TC	$257.04	$323.59	$407.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $426.58	Professional		$151.36	$302.00	$426.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $263.03 / $389.05	Professional	TC	$87.10	$263.03	$389.05
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $52.48 / $53.70	Facility	26	$43.65	$52.48	$53.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $190.55 / $257.04	Professional	TC	$141.25	$190.55	$257.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $6.46 / $30.20 / $43.65	Facility	26	$6.46	$30.20	$43.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $323.59 / $467.74	Professional		$208.93	$323.59	$467.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $251.19 / $426.58	Professional	TC	$141.25	$251.19	$426.58
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $316.23 / $467.74	Professional		$229.09	$316.23	$467.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $263.03 / $398.11	Professional	TC	$177.83	$263.03	$398.11
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $269.15 / $457.09	Professional		$134.90	$269.15	$457.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $213.80 / $380.19	Professional	TC	$107.15	$213.80	$380.19