Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.36 / $27.36 / $30.14	Facility	26	$27.36	$27.36	$30.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $50.17 / $88.45	Professional		$39.97	$50.17	$88.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $13.58 / $29.12	Professional	26	$11.24	$13.58	$29.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.27 / $36.59 / $69.73	Professional	TC	$28.27	$36.59	$69.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.27 / $80.31 / $120.38	Professional		$46.27	$80.31	$120.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.60 / $23.67 / $33.19	Professional	26	$13.60	$23.67	$33.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.72 / $56.63 / $89.31	Professional	TC	$32.72	$56.63	$89.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.02 / $95.09 / $120.54	Professional		$85.02	$95.09	$120.54
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.02 / $25.65 / $30.51	Professional	26	$22.02	$25.65	$30.51
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $59.09 / $69.89 / $83.88	Professional	TC	$59.09	$69.89	$83.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.76 / $75.29 / $116.15	Professional		$63.76	$75.29	$116.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.30 / $22.35 / $36.60	Professional	26	$16.30	$22.35	$36.60
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $17.44 / $23.80 / $24.12	Facility	26	$17.44	$23.80	$24.12
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $15.83 / $20.52 / $26.28	Professional	26	$15.83	$20.52	$26.28
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $35.54 / $52.44 / $64.98	Professional	TC	$35.54	$52.44	$64.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $57.34 / $84.92 / $112.52	Professional		$57.34	$84.92	$112.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $13.81 / $24.59 / $33.19	Professional	26	$13.81	$24.59	$33.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.03 / $58.31 / $89.31	Professional	TC	$34.03	$58.31	$89.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $838.61 / $838.61 / $838.61	Facility	26	$838.61	$838.61	$838.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.05 / $85.53 / $111.81	Professional		$54.05	$85.53	$111.81
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.30 / $25.62 / $34.11	Professional	26	$15.30	$25.62	$34.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.42 / $60.39 / $79.69	Professional	TC	$37.42	$60.39	$79.69
United Facility/Professional Professional Modifier Low / Median / High Price $54.40 / $79.98 / $118.67	Professional		$54.40	$79.98	$118.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.28 / $25.56 / $38.29	Professional	26	$17.28	$25.56	$38.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $54.50 / $84.56	Professional	TC	$38.76	$54.50	$84.56