Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,096.44 / $7,920.26 / $20,400.00	Facility		$1,096.44	$7,920.26	$20,400.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $201.78 / $219.29 / $241.13	Facility	53	$201.78	$219.29	$241.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $784.47 / $1,114.16 / $1,268.33	Professional		$784.47	$1,114.16	$1,268.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $674.33 / $987.31 / $1,449.81	Facility		$674.33	$987.31	$1,449.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $727.72 / $955.63 / $1,031.56	Facility		$727.72	$955.63	$1,031.56
Providence Facility/Professional Facility Modifier Low / Median / High Price $674.33 / $1,097.39 / $1,361.56	Facility		$674.33	$1,097.39	$1,361.56
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $28,175.85 / $35,294.44 / $42,789.49	Facility		$28,175.85	$35,294.44	$42,789.49
United Facility/Professional Facility Modifier Low / Median / High Price $3,960.00 / $25,156.00 / $55,640.00	Facility		$3,960.00	$25,156.00	$55,640.00