Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,643.52 / $7,920.26 / $15,978.56	Facility		$1,643.52	$7,920.26	$15,978.56
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,116.90 / $1,232.64 / $1,379.75	Facility	54	$1,116.90	$1,232.64	$1,379.75
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $223.38 / $246.53 / $275.95	Facility	55	$223.38	$246.53	$275.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $749.66 / $1,136.80 / $3,821.36	Professional		$749.66	$1,136.80	$3,821.36
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $598.04 / $860.37 / $1,772.04	Professional	54	$598.04	$860.37	$1,772.04
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $119.61 / $172.07 / $554.78	Professional	55	$119.61	$172.07	$554.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,318.00 / $1,318.00 / $1,318.00	Facility		$1,318.00	$1,318.00	$1,318.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $800.87 / $1,334.66 / $1,975.39	Professional		$800.87	$1,334.66	$1,975.39
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $747.69 / $1,559.04 / $1,732.27	Professional		$747.69	$1,559.04	$1,732.27
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $803.72 / $1,342.30 / $2,466.39	Facility		$803.72	$1,342.30	$2,466.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,178.97 / $1,352.40 / $2,225.37	Professional		$1,178.97	$1,352.40	$2,225.37
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,092.06 / $1,450.77 / $1,619.16	Facility		$1,092.06	$1,450.77	$1,619.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $945.55 / $1,731.27 / $8,650.00	Facility		$945.55	$1,731.27	$8,650.00
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $577.02 / $1,385.02 / $1,385.02	Facility	54	$577.02	$1,385.02	$1,385.02
Providence Facility/Professional Facility Modifier 55 Low / Median / High Price $123.65 / $346.25 / $346.25	Facility	55	$123.65	$346.25	$346.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,218.24 / $1,466.63 / $1,985.28	Professional		$1,218.24	$1,466.63	$1,985.28
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $1,086.61 / $1,143.71 / $1,588.22	Professional	54	$1,086.61	$1,143.71	$1,588.22
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $271.66 / $285.93 / $397.06	Professional	55	$271.66	$285.93	$397.06
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,698.81 / $7,379.02 / $8,723.76	Facility		$5,698.81	$7,379.02	$8,723.76
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $8,548.21 / $11,068.53 / $13,085.64	Facility	50	$8,548.21	$11,068.53	$13,085.64
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,346.30 / $1,449.97 / $2,074.08	Professional		$1,346.30	$1,449.97	$2,074.08
United Facility/Professional Facility Modifier Low / Median / High Price $1,981.00 / $9,074.00 / $12,786.00	Facility		$1,981.00	$9,074.00	$12,786.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,017.60 / $1,472.34 / $2,191.23	Professional		$1,017.60	$1,472.34	$2,191.23