Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $40.74 / $40.74	Facility		$40.74	$40.74	$40.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $32.36 / $40.74	Facility	TC	$32.36	$32.36	$40.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $19.95 / $74.13	Professional		$13.80	$19.95	$74.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $24.55 / $52.48	Professional	26	$10.00	$24.55	$52.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.25 / $7.94 / $15.85	Professional	TC	$5.25	$7.94	$15.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $13.18 / $13.18 / $13.18	Facility		$13.18	$13.18	$13.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $17.78 / $30.90	Professional		$8.91	$17.78	$30.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.23 / $20.42	Professional	26	$6.03	$10.23	$20.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.02 / $7.41 / $13.18	Professional	TC	$3.02	$7.41	$13.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $38.90 / $56.23	Professional		$19.50	$38.90	$56.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $22.39 / $32.36	Professional	26	$11.22	$22.39	$32.36
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $8.13 / $16.60 / $23.44	Professional	TC	$8.13	$16.60	$23.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $15.85 / $27.54 / $52.48	Facility		$15.85	$27.54	$52.48
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $32.36 / $40.74	Facility	TC	$32.36	$32.36	$40.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $34.67 / $67.61	Professional		$20.89	$34.67	$67.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $20.89 / $39.81	Professional	26	$12.02	$20.89	$39.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.03 / $13.80 / $26.30	Professional	TC	$6.03	$13.80	$26.30
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $39.81 / $42.66	Facility		$30.20	$39.81	$42.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $23.44 / $24.55	Facility	26	$19.05	$23.44	$24.55
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $11.22 / $16.22 / $17.38	Facility	TC	$11.22	$16.22	$17.38
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $21.88 / $26.92	Professional	26	$16.22	$21.88	$26.92
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $12.88 / $19.05	Professional	TC	$9.77	$12.88	$19.05
Providence Facility/Professional Facility Modifier Low / Median / High Price $16.22 / $28.18 / $53.70	Facility		$16.22	$28.18	$53.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $38.90 / $60.26	Professional		$16.60	$38.90	$60.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $12.59 / $34.67	Professional	26	$7.24	$12.59	$34.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $4.68 / $9.12 / $24.55	Professional	TC	$4.68	$9.12	$24.55
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $41.69 / $64.57	Professional		$24.55	$41.69	$64.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $24.55 / $37.15	Professional	26	$13.80	$24.55	$37.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $16.98 / $26.92	Professional	TC	$10.47	$16.98	$26.92
United Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $21.88 / $64.57	Professional		$12.59	$21.88	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.88 / $38.02	Professional	26	$7.76	$12.88	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $5.25 / $8.91 / $26.30	Professional	TC	$5.25	$8.91	$26.30