Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,143.55 / $4,684.68 / $7,920.26	Facility		$1,143.55	$4,684.68	$7,920.26
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $901.15 / $1,045.30 / $1,293.16	Facility	54	$901.15	$1,045.30	$1,293.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $517.96 / $751.71 / $1,615.83	Professional		$517.96	$751.71	$1,615.83
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $388.47 / $697.29 / $1,660.82	Professional	54	$388.47	$697.29	$1,660.82
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $77.69 / $139.46 / $332.16	Professional	55	$77.69	$139.46	$332.16
Cigna Facility/Professional Facility Modifier Low / Median / High Price $451.00 / $451.00 / $451.00	Facility		$451.00	$451.00	$451.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $656.94 / $1,064.43 / $1,769.65	Professional		$656.94	$1,064.43	$1,769.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $705.80 / $1,352.84 / $1,618.45	Professional		$705.80	$1,352.84	$1,618.45
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $654.39 / $1,085.02 / $1,658.68	Facility		$654.39	$1,085.02	$1,658.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $936.87 / $1,113.02 / $1,804.50	Professional		$936.87	$1,113.02	$1,804.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $807.66 / $1,256.95 / $1,386.90	Facility		$807.66	$1,256.95	$1,386.90
Providence Facility/Professional Facility Modifier Low / Median / High Price $716.12 / $1,286.46 / $2,573.00	Facility		$716.12	$1,286.46	$2,573.00
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $695.92 / $1,298.94 / $1,298.94	Facility	54	$695.92	$1,298.94	$1,298.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $956.45 / $1,283.97 / $1,726.21	Professional		$956.45	$1,283.97	$1,726.21
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,008.80 / $1,035.26 / $1,368.58	Professional	54	$1,008.80	$1,035.26	$1,368.58
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $252.20 / $258.82 / $342.14	Professional	55	$252.20	$258.82	$342.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,274.53 / $2,981.90 / $3,790.07	Facility		$2,274.53	$2,981.90	$3,790.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,091.68 / $1,328.46 / $1,805.76	Professional		$1,091.68	$1,328.46	$1,805.76
United Facility/Professional Facility Modifier Low / Median / High Price $1,689.00 / $5,130.00 / $7,385.00	Facility		$1,689.00	$5,130.00	$7,385.00
United Facility/Professional Professional Modifier Low / Median / High Price $864.90 / $1,270.36 / $1,827.45	Professional		$864.90	$1,270.36	$1,827.45