Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $85.11 / $100.00	Facility	26	$52.48	$85.11	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $123.03 / $269.15	Professional		$72.44	$123.03	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $77.62 / $173.78	Professional	TC	$46.77	$77.62	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $323.59	Professional		$128.82	$223.87	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $144.54 / $234.42	Professional	TC	$75.86	$144.54	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $239.88 / $295.12	Professional		$213.80	$239.88	$295.12
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $102.33	Professional	26	$75.86	$85.11	$102.33
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $151.36 / $190.55	Professional	TC	$134.90	$151.36	$190.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $223.87 / $331.13	Professional		$154.88	$223.87	$331.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $151.36 / $223.87	Professional	TC	$100.00	$151.36	$223.87
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $77.62 / $79.43	Facility	26	$64.57	$77.62	$79.43
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $123.03 / $173.78	Professional	TC	$72.44	$123.03	$173.78
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $64.57	Facility	26	$9.77	$45.71	$64.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $316.23	Professional		$165.96	$234.42	$316.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $204.17	Professional	TC	$91.20	$147.91	$204.17
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility	26	$2,290.87	$2,290.87	$2,290.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $288.40	Professional		$177.83	$229.09	$288.40
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $186.21	Professional	TC	$97.72	$144.54	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $162.18 / $295.12	Professional		$102.33	$162.18	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $107.15 / $186.21	Professional	TC	$60.26	$107.15	$186.21