Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $258.14 / $4,704.00 / $8,728.00	Facility		$258.14	$4,704.00	$8,728.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $185.83 / $260.83 / $296.92	Professional		$185.83	$260.83	$296.92
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $113.11 / $226.18 / $340.07	Facility		$113.11	$226.18	$340.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $151.52 / $226.38 / $243.21	Facility		$151.52	$226.38	$243.21
Providence Facility/Professional Facility Modifier Low / Median / High Price $113.11 / $246.67 / $340.07	Facility		$113.11	$246.67	$340.07
Providence Facility/Professional Facility Modifier 62 Low / Median / High Price $181.18 / $181.18 / $181.18	Facility	62	$181.18	$181.18	$181.18
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $46.38 / $46.38 / $46.38	Facility	80	$46.38	$46.38	$46.38
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $39.42 / $39.42 / $39.42	Facility	AS	$39.42	$39.42	$39.42
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