Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.54 / $137.29 / $285.00	Facility		$53.54	$137.29	$285.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $94.87 / $226.00 / $821.06	Facility	25	$94.87	$226.00	$821.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.31 / $93.74 / $236.00	Professional		$56.31	$93.74	$236.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $55.81 / $96.22 / $247.18	Professional	25	$55.81	$96.22	$247.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $88.08 / $118.05	Facility		$88.08	$88.08	$118.05
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $127.36 / $227.17	Professional		$56.75	$127.36	$227.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.21 / $169.17 / $221.82	Professional		$125.21	$169.17	$221.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $60.54 / $118.30 / $176.80	Facility		$60.54	$118.30	$176.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $88.45 / $129.78 / $220.93	Professional		$88.45	$129.78	$220.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $84.19 / $141.37 / $182.91	Facility		$84.19	$141.37	$182.91
Providence Facility/Professional Facility Modifier Low / Median / High Price $62.16 / $118.30 / $213.60	Facility		$62.16	$118.30	$213.60
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $157.19 / $228.64	Professional		$95.00	$157.19	$228.64
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $66.23 / $66.23 / $66.23	Facility		$66.23	$66.23	$66.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $108.38 / $159.60 / $235.84	Professional		$108.38	$159.60	$235.84
United Facility/Professional Professional Modifier Low / Median / High Price $97.06 / $142.09 / $237.99	Professional		$97.06	$142.09	$237.99