Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,412.64 / $4,704.00 / $8,728.00	Facility		$1,412.64	$4,704.00	$8,728.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,034.72 / $1,479.79 / $1,666.10	Professional		$1,034.72	$1,479.79	$1,666.10
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $840.30 / $1,310.45 / $1,806.65	Facility		$840.30	$1,310.45	$1,806.65
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $882.45 / $1,207.41 / $1,290.42	Facility		$882.45	$1,207.41	$1,290.42
Providence Facility/Professional Facility Modifier Low / Median / High Price $840.30 / $1,547.12 / $2,724.00	Facility		$840.30	$1,547.12	$2,724.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $11,927.24 / $16,067.82 / $19,370.28	Facility		$11,927.24	$16,067.82	$19,370.28
United Facility/Professional Facility Modifier Low / Median / High Price $3,028.00 / $18,628.00 / $26,255.00	Facility		$3,028.00	$18,628.00	$26,255.00