Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.49 / $111.15 / $226.36	Facility	26	$94.49	$111.15	$226.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $271.07 / $323.29 / $709.48	Professional		$271.07	$323.29	$709.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.66 / $114.99 / $257.12	Professional	26	$100.66	$114.99	$257.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.43 / $208.30 / $452.37	Professional	TC	$170.43	$208.30	$452.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $238.79 / $280.00 / $323.44	Professional		$238.79	$280.00	$323.44
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.23 / $104.68 / $118.16	Professional	26	$87.23	$104.68	$118.16
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $151.56 / $174.83 / $205.29	Professional	TC	$151.56	$174.83	$205.29
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $297.48 / $297.48 / $345.04	Professional		$297.48	$297.48	$345.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $60.76 / $83.64 / $89.11	Facility	26	$60.76	$83.64	$89.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $73.59 / $93.79	Professional	26	$49.45	$73.59	$93.79
Pacific Source Facility/Professional Professional Modifier TC Low / Median / High Price $94.98 / $135.19 / $225.61	Professional	TC	$94.98	$135.19	$225.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.14 / $285.68 / $359.09	Professional		$204.14	$285.68	$359.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $59.34 / $93.11	Professional	26	$59.34	$59.34	$93.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.83 / $102.83 / $183.95	Professional	TC	$102.83	$102.83	$183.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $221.73 / $278.76 / $342.05	Professional		$221.73	$278.76	$342.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.59 / $103.34 / $126.02	Professional	26	$79.59	$103.34	$126.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $142.72 / $175.49 / $216.03	Professional	TC	$142.72	$175.49	$216.03
United Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $283.42 / $400.70	Professional		$101.04	$283.42	$400.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.57 / $51.36 / $141.50	Professional	26	$37.57	$51.36	$141.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.61 / $106.29 / $242.56	Professional	TC	$62.61	$106.29	$242.56