Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $989.75 / $11,050.00 / $15,978.56	Facility		$989.75	$11,050.00	$15,978.56
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,121.78 / $13,801.00 / $20,535.00	Facility	50	$4,121.78	$13,801.00	$20,535.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $791.52 / $1,126.84 / $1,268.72	Professional		$791.52	$1,126.84	$1,268.72
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $733.34 / $996.19 / $1,576.68	Facility		$733.34	$996.19	$1,576.68
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $603.70 / $964.21 / $996.96	Facility		$603.70	$964.21	$996.96
Providence Facility/Professional Facility Modifier Low / Median / High Price $733.34 / $1,222.10 / $1,576.68	Facility		$733.34	$1,222.10	$1,576.68
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $15,334.20 / $21,141.87 / $25,621.76	Facility		$15,334.20	$21,141.87	$25,621.76
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $23,001.30 / $31,712.81 / $38,432.64	Facility	50	$23,001.30	$31,712.81	$38,432.64
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