Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $751.55 / $6,320.00 / $13,746.00	Facility		$751.55	$6,320.00	$13,746.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $457.65 / $495.20 / $542.79	Facility	52	$457.65	$495.20	$542.79
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $183.06 / $198.08 / $217.12	Facility	53	$183.06	$198.08	$217.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $706.12 / $1,001.20 / $1,139.73	Professional		$706.12	$1,001.20	$1,139.73
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $611.02 / $888.70 / $1,313.69	Facility		$611.02	$888.70	$1,313.69
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $663.28 / $860.18 / $920.01	Facility		$663.28	$860.18	$920.01
Providence Facility/Professional Facility Modifier Low / Median / High Price $611.02 / $988.24 / $1,221.79	Facility		$611.02	$988.24	$1,221.79
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