Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.22 / $162.15 / $325.95	Facility	26	$141.22	$162.15	$325.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.15 / $199.18 / $340.88	Professional		$103.15	$199.18	$340.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.65 / $64.45 / $177.74	Professional	26	$49.65	$64.45	$177.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.47 / $144.61 / $218.61	Professional	TC	$45.47	$144.61	$218.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.09 / $77.09 / $77.09	Facility	26	$77.09	$77.09	$77.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $184.84 / $268.18 / $431.56	Professional		$184.84	$268.18	$431.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.60 / $114.33 / $185.74	Professional	26	$63.60	$114.33	$185.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.64 / $154.06 / $235.61	Professional	TC	$94.64	$154.06	$235.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $243.43 / $289.68 / $329.73	Professional		$243.43	$289.68	$329.73
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $124.81 / $148.38 / $167.07	Professional	26	$124.81	$148.38	$167.07
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $116.04 / $138.55 / $162.68	Professional	TC	$116.04	$138.55	$162.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $202.50 / $256.27 / $398.91	Professional		$202.50	$256.27	$398.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.60 / $130.66 / $201.30	Professional	26	$105.60	$130.66	$201.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.93 / $133.79 / $555.72	Professional	TC	$93.93	$133.79	$555.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $112.20 / $133.33	Facility	26	$80.00	$112.20	$133.33
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $63.60 / $97.47 / $125.61	Professional	26	$63.60	$97.47	$125.61
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $90.46 / $146.56 / $291.55	Professional	TC	$90.46	$146.56	$291.55
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $77.09 / $77.09 / $77.09	Facility	26	$77.09	$77.09	$77.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $220.82 / $295.68 / $381.04	Professional		$220.82	$295.68	$381.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.22 / $119.60 / $186.79	Professional	26	$79.22	$119.60	$186.79
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $94.64 / $152.66 / $215.94	Professional	TC	$94.64	$152.66	$215.94
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $8,401.03 / $8,401.03 / $8,401.03	Facility	26	$8,401.03	$8,401.03	$8,401.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $226.23 / $284.13 / $358.16	Professional		$226.23	$284.13	$358.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $101.12 / $136.32 / $187.61	Professional	26	$101.12	$136.32	$187.61
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $107.73 / $147.69 / $185.73	Professional	TC	$107.73	$147.69	$185.73
United Facility/Professional Professional Modifier Low / Median / High Price $140.86 / $233.43 / $404.54	Professional		$140.86	$233.43	$404.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.46 / $71.94 / $205.14	Professional	26	$57.46	$71.94	$205.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $106.00 / $199.78	Professional	TC	$69.65	$106.00	$199.78