Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $151.36	Facility		$100.00	$100.00	$151.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $151.36 / $151.36 / $186.21	Facility	TC	$151.36	$151.36	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $64.57 / $186.21	Professional		$52.48	$64.57	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $41.69 / $114.82	Professional	26	$20.89	$41.69	$114.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.90 / $77.62	Professional	TC	$30.90	$38.90	$77.62
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Facility		$64.57	$64.57	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $60.26 / $117.49	Professional		$35.48	$60.26	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $26.92 / $51.29	Professional	26	$14.79	$26.92	$51.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $37.15 / $72.44	Professional	TC	$20.42	$37.15	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $131.83 / $186.21	Professional		$66.07	$131.83	$186.21
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $52.48 / $74.13	Professional	26	$25.70	$52.48	$74.13
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $79.43 / $114.82	Professional	TC	$39.81	$79.43	$114.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $104.71 / $181.97	Facility		$50.12	$104.71	$181.97
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $151.36 / $151.36 / $186.21	Facility	TC	$151.36	$151.36	$186.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $151.36 / $213.80	Professional		$67.61	$151.36	$213.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $60.26 / $112.20	Professional	26	$26.92	$60.26	$112.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $85.11 / $131.83	Professional	TC	$39.81	$85.11	$131.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $131.83 / $151.36	Facility		$109.65	$131.83	$151.36
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $53.70 / $81.28	Facility	26	$43.65	$53.70	$81.28
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $63.10 / $74.13 / $83.18	Facility	TC	$63.10	$74.13	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $53.70 / $97.72	Professional	26	$32.36	$53.70	$97.72
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $74.13 / $95.50	Professional	TC	$45.71	$74.13	$95.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $109.65 / $190.55	Facility		$58.88	$109.65	$190.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $125.89 / $204.17	Professional		$60.26	$125.89	$204.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $28.84 / $91.20	Professional	26	$16.22	$28.84	$91.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $43.65 / $120.23	Professional	TC	$20.42	$43.65	$120.23
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $208.93 / $213.80	Facility		$208.93	$208.93	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $131.83 / $213.80	Professional		$81.28	$131.83	$213.80
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $54.95 / $85.11	Professional	26	$31.62	$54.95	$85.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $77.62 / $125.89	Professional	TC	$48.98	$77.62	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $69.18 / $208.93	Professional		$40.74	$69.18	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $28.84 / $89.13	Professional	26	$17.38	$28.84	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.81 / $125.89	Professional	TC	$23.99	$39.81	$125.89