Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $543.50 / $3,746.41 / $7,149.67	Facility		$543.50	$3,746.41	$7,149.67
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $184.82 / $350.01 / $422.24	Facility	52	$184.82	$350.01	$422.24
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $125.97 / $224.30 / $421.82	Facility	53	$125.97	$224.30	$421.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.80 / $347.01 / $948.08	Professional		$190.80	$347.01	$948.08
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $55.67 / $122.21 / $321.05	Professional	53	$55.67	$122.21	$321.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $842.71 / $842.71 / $2,310.00	Facility		$842.71	$842.71	$2,310.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $272.58 / $473.48 / $902.66	Professional		$272.58	$473.48	$902.66
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $220.49 / $220.49 / $220.49	Professional	53	$220.49	$220.49	$220.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $344.59 / $514.09 / $825.74	Professional		$344.59	$514.09	$825.74
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $345.49 / $514.09 / $825.74	Professional	53	$345.49	$514.09	$825.74
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $278.35 / $536.54 / $934.15	Facility		$278.35	$536.54	$934.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $326.39 / $557.04 / $857.23	Professional		$326.39	$557.04	$857.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $358.45 / $662.38 / $724.43	Facility		$358.45	$662.38	$724.43
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $278.58 / $378.68 / $701.76	Facility	53	$278.58	$378.68	$701.76
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $248.06 / $384.82 / $702.06	Professional	53	$248.06	$384.82	$702.06
Providence Facility/Professional Facility Modifier Low / Median / High Price $278.35 / $543.50 / $1,091.28	Facility		$278.35	$543.50	$1,091.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $348.30 / $545.97 / $891.78	Professional		$348.30	$545.97	$891.78
Providence Facility/Professional Professional Modifier 53 Low / Median / High Price $220.49 / $220.49 / $220.49	Professional	53	$220.49	$220.49	$220.49
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,153.07 / $2,975.12 / $5,200.00	Facility		$2,153.07	$2,975.12	$5,200.00
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $2,392.77 / $2,392.77 / $2,392.77	Facility	53	$2,392.77	$2,392.77	$2,392.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $350.89 / $593.35 / $925.97	Professional		$350.89	$593.35	$925.97
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $175.45 / $282.95 / $464.53	Professional	53	$175.45	$282.95	$464.53
United Facility/Professional Facility Modifier Low / Median / High Price $1,472.00 / $3,700.00 / $5,517.00	Facility		$1,472.00	$3,700.00	$5,517.00
United Facility/Professional Professional Modifier Low / Median / High Price $489.83 / $700.25 / $1,055.68	Professional		$489.83	$700.25	$1,055.68
United Facility/Professional Professional Modifier 53 Low / Median / High Price $220.49 / $609.76 / $736.57	Professional	53	$220.49	$609.76	$736.57