Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.81 / $198.80 / $308.38	Facility		$109.81	$198.80	$308.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.12 / $91.51 / $263.20	Professional		$57.12	$91.51	$263.20
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $119.16 / $119.16 / $119.16	Professional	25	$119.16	$119.16	$119.16
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $57.12 / $57.12 / $57.12	Professional	CQ	$57.12	$57.12	$57.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $108.00 / $120.00	Facility		$75.00	$108.00	$120.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.58 / $127.74 / $265.20	Professional		$74.58	$127.74	$265.20
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.24 / $223.07 / $257.27	Professional		$162.24	$223.07	$257.27
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $85.45 / $119.88 / $266.05	Facility		$85.45	$119.88	$266.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $115.65 / $161.72 / $258.22	Professional		$115.65	$161.72	$258.22
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $115.57 / $168.72 / $201.67	Facility		$115.57	$168.72	$201.67
Providence Facility/Professional Facility Modifier Low / Median / High Price $83.84 / $108.00 / $240.65	Facility		$83.84	$108.00	$240.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.94 / $178.85 / $265.20	Professional		$98.94	$178.85	$265.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $149.12 / $269.64 / $393.38	Facility		$149.12	$269.64	$393.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.76 / $122.01 / $273.60	Professional		$107.76	$122.01	$273.60
United Facility/Professional Professional Modifier Low / Median / High Price $78.93 / $87.70 / $220.19	Professional		$78.93	$87.70	$220.19