Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.97 / $93.96 / $275.50	Facility		$52.97	$93.96	$275.50
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $89.90 / $164.97 / $284.49	Facility	25	$89.90	$164.97	$284.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.47 / $57.10 / $148.00	Professional		$32.47	$57.10	$148.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $35.02 / $63.20 / $151.10	Professional	25	$35.02	$63.20	$151.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.99 / $46.99 / $74.01	Facility		$46.99	$46.99	$74.01
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $29.37 / $29.37 / $29.37	Facility	62	$29.37	$29.37	$29.37
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $4.70 / $4.70 / $4.70	Facility	AS	$4.70	$4.70	$4.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.22 / $74.02 / $141.41	Professional		$34.22	$74.02	$141.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.81 / $91.38 / $140.99	Professional		$66.81	$91.38	$140.99
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.70 / $63.86 / $105.84	Facility		$35.70	$63.86	$105.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $74.70 / $136.72	Professional		$44.64	$74.70	$136.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $48.24 / $85.76 / $113.90	Facility		$48.24	$85.76	$113.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.76 / $66.23 / $133.30	Facility		$36.76	$66.23	$133.30
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $29.37 / $29.37 / $29.37	Facility	62	$29.37	$29.37	$29.37
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $4.70 / $4.70 / $4.70	Facility	AS	$4.70	$4.70	$4.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.03 / $86.84 / $142.38	Professional		$49.03	$86.84	$142.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $40.00 / $40.00	Facility		$40.00	$40.00	$40.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $58.36 / $93.37 / $147.84	Professional		$58.36	$93.37	$147.84
United Facility/Professional Professional Modifier Low / Median / High Price $61.56 / $85.75 / $148.21	Professional		$61.56	$85.75	$148.21