Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $134.90 / $208.93	Professional		$97.72	$134.90	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $54.95 / $93.33	Professional	26	$39.81	$54.95	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $112.20 / $239.88	Professional		$70.79	$112.20	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.65 / $97.72	Professional	26	$28.84	$43.65	$97.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $234.42 / $338.84	Professional		$117.49	$234.42	$338.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $97.72 / $138.04	Professional	26	$47.86	$97.72	$138.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $407.38	Professional		$173.78	$239.88	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $87.10 / $169.82	Professional	26	$72.44	$87.10	$169.82
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $102.33 / $138.04	Facility	26	$83.18	$102.33	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $138.04	Professional	26	$64.57	$107.15	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $245.47 / $380.19	Professional		$112.20	$245.47	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $57.54 / $147.91	Professional	26	$31.62	$57.54	$147.91
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $251.19 / $389.05	Professional		$147.91	$251.19	$389.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $107.15 / $162.18	Professional	26	$60.26	$107.15	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $128.82 / $389.05	Professional		$79.43	$128.82	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $54.95 / $162.18	Professional	26	$33.88	$54.95	$162.18