Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $22.67 / $22.67 / $22.67	Facility		$22.67	$22.67	$22.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.67 / $22.67 / $22.67	Facility	TC	$22.67	$22.67	$22.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.72 / $18.26 / $27.68	Professional		$13.72	$18.26	$27.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.07 / $12.83 / $39.00	Professional	26	$10.07	$12.83	$39.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $6.52 / $7.59 / $12.94	Professional	TC	$6.52	$7.59	$12.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $13.15 / $13.15 / $13.15	Facility		$13.15	$13.15	$13.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $8.80 / $23.33 / $30.62	Professional		$8.80	$23.33	$30.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.00 / $13.56 / $20.25	Professional	26	$6.00	$13.56	$20.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $2.57 / $9.77 / $13.17	Professional	TC	$2.57	$9.77	$13.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.34 / $40.06 / $57.10	Professional		$19.34	$40.06	$57.10
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $23.78 / $33.89	Professional	26	$11.48	$23.78	$33.89
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $7.86 / $16.28 / $23.21	Professional	TC	$7.86	$16.28	$23.21
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $14.09 / $26.11 / $53.95	Facility		$14.09	$26.11	$53.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $27.60 / $33.50 / $64.70	Professional		$27.60	$33.50	$64.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.21 / $21.45 / $38.18	Professional	26	$19.21	$21.45	$38.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.00 / $13.35 / $26.54	Professional	TC	$6.00	$13.35	$26.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $26.91 / $38.64 / $42.21	Facility		$26.91	$38.64	$42.21
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $14.87 / $23.08 / $24.48	Facility	26	$14.87	$23.08	$24.48
Pacific Source Facility/Professional Facility Modifier TC Low / Median / High Price $10.05 / $14.91 / $17.42	Facility	TC	$10.05	$14.91	$17.42
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $22.23 / $29.52	Professional	26	$16.96	$22.23	$29.52
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $9.69 / $14.82 / $20.54	Professional	TC	$9.69	$14.82	$20.54
Providence Facility/Professional Facility Modifier Low / Median / High Price $17.87 / $47.24 / $59.17	Facility		$17.87	$47.24	$59.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $23.33 / $40.19 / $59.17	Professional		$23.33	$40.19	$59.17
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.27 / $13.56 / $20.79	Professional	26	$7.27	$13.56	$20.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $3.92 / $9.77 / $15.05	Professional	TC	$3.92	$9.77	$15.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $36.51 / $41.58 / $65.15	Professional		$36.51	$41.58	$65.15
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.55 / $24.54 / $38.36	Professional	26	$21.55	$24.54	$38.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $14.96 / $17.04 / $27.77	Professional	TC	$14.96	$17.04	$27.77
United Facility/Professional Professional Modifier Low / Median / High Price $13.20 / $33.02 / $64.29	Professional		$13.20	$33.02	$64.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.79 / $12.81 / $37.95	Professional	26	$7.79	$12.81	$37.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $5.41 / $8.89 / $26.34	Professional	TC	$5.41	$8.89	$26.34