Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $191.24 / $220.63 / $445.06	Facility	26	$191.24	$220.63	$445.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.75 / $172.13 / $265.00	Professional	26	$118.75	$172.13	$265.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.14 / $175.84 / $259.61	Professional	26	$92.14	$175.84	$259.61
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.85 / $202.58 / $209.56	Professional	26	$87.85	$202.58	$209.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $141.44 / $181.57 / $281.16	Professional	26	$141.44	$181.57	$281.16
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $130.83 / $175.04 / $181.44	Facility	26	$130.83	$175.04	$181.44
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.34 / $155.04 / $192.29	Professional	26	$109.34	$155.04	$192.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $95.96 / $172.94 / $259.61	Professional	26	$95.96	$172.94	$259.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,641.51 / $4,641.51 / $4,641.51	Facility	26	$4,641.51	$4,641.51	$4,641.51
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $166.53 / $206.56 / $252.98	Professional	26	$166.53	$206.56	$252.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.68 / $120.90 / $296.37	Professional	26	$80.68	$120.90	$296.37