Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $165.96 / $281.84	Facility		$100.00	$165.96	$281.84
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $128.82 / $389.05 / $426.58	Facility	25	$128.82	$389.05	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $123.03 / $346.74	Professional		$70.79	$123.03	$346.74
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $72.44 / $134.90 / $331.13	Professional	25	$72.44	$134.90	$331.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Facility		$147.91	$147.91	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $151.36 / $263.03	Professional		$81.28	$151.36	$263.03
HealthNet Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $281.84 / $316.23	Professional		$245.47	$281.84	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $275.42	Professional		$128.82	$190.55	$275.42
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $125.89 / $213.80	Facility		$74.13	$125.89	$213.80
Moda Health Facility/Professional Facility Modifier 25 Low / Median / High Price $128.82 / $281.84 / $426.58	Facility	25	$128.82	$281.84	$426.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $147.91 / $269.15	Professional		$85.11	$147.91	$269.15
Moda Health Facility/Professional Professional Modifier 25 Low / Median / High Price $77.62 / $138.04 / $302.00	Professional	25	$77.62	$138.04	$302.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $204.17 / $223.87	Facility		$147.91	$204.17	$223.87
Providence Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $120.23 / $204.17	Facility		$72.44	$120.23	$204.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $181.97 / $281.84	Professional		$79.43	$181.97	$281.84
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $194.98 / $275.42	Professional		$134.90	$194.98	$275.42
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $93.33	Facility		$69.18	$69.18	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $245.47	Professional		$91.20	$154.88	$245.47