Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $256.02 / $4,684.68 / $8,728.00	Facility		$256.02	$4,684.68	$8,728.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.82 / $120.82 / $120.82	Facility		$120.82	$120.82	$120.82
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $11.78 / $11.78 / $11.78	Facility	AS	$11.78	$11.78	$11.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.75 / $237.60 / $267.52	Professional		$197.75	$237.60	$267.52
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $99.20 / $183.37 / $266.89	Facility		$99.20	$183.37	$266.89
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $151.34 / $203.83 / $213.52	Facility		$151.34	$203.83	$213.52
Providence Facility/Professional Facility Modifier Low / Median / High Price $99.25 / $188.48 / $271.16	Facility		$99.25	$188.48	$271.16
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $11.78 / $34.29 / $34.29	Facility	AS	$11.78	$34.29	$34.29
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $861.54 / $1,116.86 / $1,502.14	Facility		$861.54	$1,116.86	$1,502.14
United Facility/Professional Facility Modifier Low / Median / High Price $376.00 / $3,290.00 / $6,216.00	Facility		$376.00	$3,290.00	$6,216.00