Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $988.00 / $5,116.62 / $8,728.00	Facility		$988.00	$5,116.62	$8,728.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $187.41 / $229.32 / $253.15	Professional		$187.41	$229.32	$253.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $601.15 / $700.18 / $839.11	Professional		$601.15	$700.18	$839.11
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $253.15 / $265.81 / $582.17	Facility		$253.15	$265.81	$582.17
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $309.05 / $2,768.05 / $3,856.64	Facility		$309.05	$2,768.05	$3,856.64
Providence Facility/Professional Facility Modifier Low / Median / High Price $249.04 / $260.74 / $582.17	Facility		$249.04	$260.74	$582.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $298.07 / $298.07 / $671.59	Professional		$298.07	$298.07	$671.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $814.10 / $9,882.69 / $13,475.61	Facility		$814.10	$9,882.69	$13,475.61
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $374.18 / $608.08 / $805.07	Professional		$374.18	$608.08	$805.07
United Facility/Professional Facility Modifier Low / Median / High Price $2,155.00 / $12,835.00 / $26,404.00	Facility		$2,155.00	$12,835.00	$26,404.00
United Facility/Professional Professional Modifier Low / Median / High Price $335.58 / $460.60 / $735.15	Professional		$335.58	$460.60	$735.15