Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,102.41 / $7,920.26 / $20,400.00	Facility		$1,102.41	$7,920.26	$20,400.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $849.88 / $1,221.04 / $1,374.77	Professional		$849.88	$1,221.04	$1,374.77
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $619.45 / $1,032.31 / $1,415.24	Facility		$619.45	$1,032.31	$1,415.24
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $700.59 / $968.82 / $1,075.34	Facility		$700.59	$968.82	$1,075.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $619.45 / $1,148.40 / $1,369.53	Facility		$619.45	$1,148.40	$1,369.53
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $203.51 / $203.51 / $203.51	Facility	80	$203.51	$203.51	$203.51
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $172.99 / $172.99 / $172.99	Facility	AS	$172.99	$172.99	$172.99
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $12,039.76 / $15,838.63 / $18,619.91	Facility		$12,039.76	$15,838.63	$18,619.91
United Facility/Professional Facility Modifier Low / Median / High Price $2,155.00 / $12,835.00 / $26,404.00	Facility		$2,155.00	$12,835.00	$26,404.00