Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $141.25 / $165.96	Facility	26	$89.13	$141.25	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $190.55 / $309.03	Professional		$107.15	$190.55	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $154.88	Professional	26	$50.12	$66.07	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $93.33 / $186.21	Professional	TC	$51.29	$93.33	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $478.63	Professional		$162.18	$275.42	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $114.82 / $190.55	Professional	26	$61.66	$114.82	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $154.88 / $398.11	Professional	TC	$87.10	$154.88	$398.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $269.15 / $331.13	Professional		$239.88	$269.15	$331.13
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $138.04 / $165.96	Professional	26	$123.03	$138.04	$165.96
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $131.83 / $162.18	Professional	TC	$114.82	$131.83	$162.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $478.63	Professional		$194.98	$269.15	$478.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $125.89 / $194.98	Professional	26	$66.07	$125.89	$194.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $138.04 / $549.54	Professional	TC	$93.33	$138.04	$549.54
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $109.65 / $131.83	Facility	26	$91.20	$109.65	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $95.50 / $128.82	Professional	26	$64.57	$95.50	$128.82
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $269.15	Professional	TC	$91.20	$144.54	$269.15
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.60 / $77.62 / $109.65	Facility	26	$16.60	$77.62	$109.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $281.84 / $407.38	Professional		$218.78	$281.84	$407.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $117.49 / $190.55	Professional	26	$81.28	$117.49	$190.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $165.96 / $316.23	Professional	TC	$100.00	$165.96	$316.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $8,317.64 / $8,317.64 / $8,317.64	Facility	26	$8,317.64	$8,317.64	$8,317.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $275.42 / $346.74	Professional		$229.09	$275.42	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $131.83 / $181.97	Professional	26	$97.72	$131.83	$181.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $144.54 / $186.21	Professional	TC	$109.65	$144.54	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $245.47 / $426.58	Professional		$141.25	$245.47	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $177.83	Professional	26	$57.54	$75.86	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $123.03 / $288.40	Professional	TC	$69.18	$123.03	$288.40