Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $206.59 / $2,747.00 / $7,920.26	Facility		$206.59	$2,747.00	$7,920.26
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $137.78 / $176.68 / $238.20	Facility	54	$137.78	$176.68	$238.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $78.00 / $78.00 / $78.00	Facility		$78.00	$78.00	$78.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $197.99 / $245.34 / $314.80	Professional		$197.99	$245.34	$314.80
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $122.09 / $182.02 / $278.75	Facility		$122.09	$182.02	$278.75
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $141.51 / $219.43 / $258.62	Facility		$141.51	$219.43	$258.62
Providence Facility/Professional Facility Modifier Low / Median / High Price $121.48 / $178.77 / $293.08	Facility		$121.48	$178.77	$293.08
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $234.47 / $234.47 / $234.47	Facility	54	$234.47	$234.47	$234.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $564.70 / $724.26 / $890.90	Facility		$564.70	$724.26	$890.90
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