Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $811.59 / $2,747.00 / $7,920.26	Facility		$811.59	$2,747.00	$7,920.26
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $405.79 / $465.75 / $526.79	Facility	52	$405.79	$465.75	$526.79
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $608.69 / $790.19 / $1,308.33	Facility	54	$608.69	$790.19	$1,308.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $550.00 / $550.00 / $550.00	Facility		$550.00	$550.00	$550.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $801.52 / $939.53 / $1,127.17	Professional		$801.52	$939.53	$1,127.17
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $532.11 / $731.52 / $971.55	Facility		$532.11	$731.52	$971.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $503.97 / $762.46 / $864.30	Facility		$503.97	$762.46	$864.30
Providence Facility/Professional Facility Modifier Low / Median / High Price $544.22 / $800.39 / $1,235.24	Facility		$544.22	$800.39	$1,235.24
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $788.86 / $788.86 / $788.86	Facility	54	$788.86	$788.86	$788.86
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $564.70 / $724.26 / $933.97	Facility		$564.70	$724.26	$933.97
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