Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.06 / $100.06 / $100.06	Facility		$100.06	$100.06	$100.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $104.96 / $104.96 / $104.96	Facility	TC	$104.96	$104.96	$104.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.79 / $59.35 / $99.52	Professional		$51.79	$59.35	$99.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $27.83 / $75.53	Professional	26	$20.98	$27.83	$75.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.24 / $40.84 / $52.54	Professional	TC	$32.24	$40.84	$52.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.65 / $64.65 / $64.65	Facility		$64.65	$64.65	$64.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.56 / $72.91 / $116.72	Professional		$36.56	$72.91	$116.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $30.13 / $51.40	Professional	26	$16.16	$30.13	$51.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $42.78 / $72.62	Professional	TC	$20.39	$42.78	$72.62
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.78 / $134.18 / $191.26	Professional		$64.78	$134.18	$191.26
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $25.66 / $53.15 / $75.76	Professional	26	$25.66	$53.15	$75.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $39.11 / $81.03 / $115.50	Professional	TC	$39.11	$81.03	$115.50
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $44.91 / $87.45 / $239.09	Facility		$44.91	$87.45	$239.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $151.34 / $215.36	Professional		$97.83	$151.34	$215.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $81.33 / $111.22	Professional	26	$42.70	$81.33	$111.22
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.65 / $87.10 / $130.51	Professional	TC	$65.65	$87.10	$130.51
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $93.02 / $128.63 / $146.32	Facility		$93.02	$128.63	$146.32
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $39.24 / $53.15 / $94.62	Facility	26	$39.24	$53.15	$94.62
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $53.78 / $74.53 / $83.08	Facility	TC	$53.78	$74.53	$83.08
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $47.40 / $55.24 / $88.00	Professional	26	$47.40	$55.24	$88.00
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $45.20 / $76.59 / $93.48	Professional	TC	$45.20	$76.59	$93.48
Providence Facility/Professional Facility Modifier Low / Median / High Price $60.73 / $159.86 / $197.88	Facility		$60.73	$159.86	$197.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $72.91 / $128.85 / $195.02	Professional		$72.91	$128.85	$195.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $30.13 / $60.10	Professional	26	$16.16	$30.13	$60.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $42.78 / $74.59	Professional	TC	$20.39	$42.78	$74.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $203.33 / $203.33 / $204.49	Facility		$203.33	$203.33	$204.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $119.10 / $132.69 / $217.87	Professional		$119.10	$132.69	$217.87
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $54.54 / $85.44	Professional	26	$47.88	$54.54	$85.44
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $71.22 / $78.26 / $132.43	Professional	TC	$71.22	$78.26	$132.43
United Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $68.56 / $209.76	Professional		$41.14	$68.56	$209.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.32 / $28.87 / $88.52	Professional	26	$17.32	$28.87	$88.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $23.82 / $83.32	Professional	TC	$23.82	$23.82	$83.32