Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.00 / $60.00 / $67.01	Facility	26	$60.00	$60.00	$67.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.30 / $186.47 / $419.12	Professional		$138.30	$186.47	$419.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.16 / $154.21 / $355.09	Professional	TC	$114.16	$154.21	$355.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.71 / $30.71 / $30.71	Facility	26	$30.71	$30.71	$30.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.31 / $309.49 / $499.43	Professional		$164.31	$309.49	$499.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.63 / $248.61 / $430.25	Professional	TC	$138.63	$248.61	$430.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $318.89 / $415.79 / $483.84	Professional		$318.89	$415.79	$483.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $61.53 / $69.31	Professional	26	$47.19	$61.53	$69.31
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $264.33 / $353.08 / $414.52	Professional	TC	$264.33	$353.08	$414.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $191.64 / $299.44 / $504.24	Professional		$191.64	$299.44	$504.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.52 / $258.52 / $476.39	Professional	TC	$90.52	$258.52	$476.39
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.22 / $51.59 / $53.60	Facility	26	$38.22	$51.59	$53.60
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $133.50 / $196.62 / $268.39	Professional	TC	$133.50	$196.62	$268.39
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.71 / $30.71 / $30.71	Facility	26	$30.71	$30.71	$30.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $214.92 / $330.69 / $455.38	Professional		$214.92	$330.69	$455.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.63 / $296.06 / $438.63	Professional	TC	$138.63	$296.06	$438.63
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $459.43 / $459.43 / $459.43	Facility	26	$459.43	$459.43	$459.43
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $254.45 / $330.58 / $469.96	Professional		$254.45	$330.58	$469.96
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $213.92 / $277.93 / $395.11	Professional	TC	$213.92	$277.93	$395.11
United Facility/Professional Professional Modifier Low / Median / High Price $202.51 / $282.95 / $476.87	Professional		$202.51	$282.95	$476.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $160.91 / $237.21 / $439.52	Professional	TC	$160.91	$237.21	$439.52