Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $195.29 / $223.87 / $450.75	Facility	26	$195.29	$223.87	$450.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.01 / $261.97 / $474.42	Professional		$128.01	$261.97	$474.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.81 / $83.66 / $228.97	Professional	26	$57.81	$83.66	$228.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.69 / $180.21 / $266.48	Professional	TC	$53.69	$180.21	$266.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.18 / $364.94 / $556.94	Professional		$236.18	$364.94	$556.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.43 / $172.71 / $260.36	Professional	26	$80.43	$172.71	$260.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.57 / $182.04 / $297.95	Professional	TC	$113.57	$182.04	$297.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.13 / $375.93 / $428.20	Professional		$316.13	$375.93	$428.20
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $172.07 / $204.88 / $230.68	Professional	26	$172.07	$204.88	$230.68
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $140.91 / $168.25 / $197.52	Professional	TC	$140.91	$168.25	$197.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $267.80 / $331.80 / $516.70	Professional		$267.80	$331.80	$516.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $121.44 / $175.89 / $275.49	Professional	26	$121.44	$175.89	$275.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.21 / $162.66 / $596.04	Professional	TC	$114.21	$162.66	$596.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $103.74 / $155.61 / $182.24	Facility	26	$103.74	$155.61	$182.24
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $85.36 / $110.40 / $155.47	Professional	26	$85.36	$110.40	$155.47
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $117.14 / $231.15 / $338.92	Professional	TC	$117.14	$231.15	$338.92
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $105.26 / $105.26 / $105.26	Facility	26	$105.26	$105.26	$105.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $287.92 / $384.79 / $491.75	Professional		$287.92	$384.79	$491.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.95 / $175.54 / $266.33	Professional	26	$102.95	$175.54	$266.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.57 / $178.88 / $279.79	Professional	TC	$113.57	$178.88	$279.79
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 $290.87 / $391.28 / $460.48	Professional		$290.87	$391.28	$460.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $126.13 / $193.15 / $256.77	Professional	26	$126.13	$193.15	$256.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.68 / $173.19 / $261.76	Professional	TC	$128.68	$173.19	$261.76
United Facility/Professional Professional Modifier Low / Median / High Price $178.28 / $232.49 / $512.24	Professional		$178.28	$232.49	$512.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.12 / $97.80 / $279.66	Professional	26	$66.12	$97.80	$279.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.48 / $136.82 / $238.65	Professional	TC	$80.48	$136.82	$238.65