Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,343.54 / $7,658.46 / $11,967.80	Facility		$1,343.54	$7,658.46	$11,967.80
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $217.39 / $240.11 / $268.70	Facility	53	$217.39	$240.11	$268.70
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $815.21 / $900.42 / $1,007.66	Facility	54	$815.21	$900.42	$1,007.66
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $163.04 / $180.08 / $201.53	Facility	55	$163.04	$180.08	$201.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $525.95 / $861.60 / $3,500.28	Professional		$525.95	$861.60	$3,500.28
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $4,329.68 / $4,329.68 / $4,329.68	Professional	50	$4,329.68	$4,329.68	$4,329.68
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $291.20 / $419.01 / $1,330.91	Professional	52	$291.20	$419.01	$1,330.91
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $303.50 / $613.85 / $1,235.53	Professional	54	$303.50	$613.85	$1,235.53
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $60.70 / $106.23 / $245.09	Professional	55	$60.70	$106.23	$245.09
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 $643.99 / $1,075.78 / $1,444.40	Professional		$643.99	$1,075.78	$1,444.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $546.71 / $1,138.93 / $1,265.47	Professional		$546.71	$1,138.93	$1,265.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $587.14 / $980.84 / $1,801.72	Facility		$587.14	$980.84	$1,801.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $860.89 / $1,052.40 / $1,625.58	Professional		$860.89	$1,052.40	$1,625.58
Moda Health Facility/Professional Professional Modifier 54 Low / Median / High Price $734.13 / $734.13 / $734.13	Professional	54	$734.13	$734.13	$734.13
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $878.88 / $1,059.83 / $1,258.93	Facility		$878.88	$1,059.83	$1,258.93
Providence Facility/Professional Facility Modifier Low / Median / High Price $690.06 / $1,263.92 / $8,650.00	Facility		$690.06	$1,263.92	$8,650.00
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $120.35 / $120.35 / $120.35	Facility	53	$120.35	$120.35	$120.35
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $421.21 / $1,011.14 / $1,011.14	Facility	54	$421.21	$1,011.14	$1,011.14
Providence Facility/Professional Facility Modifier 55 Low / Median / High Price $90.26 / $252.78 / $252.78	Facility	55	$90.26	$252.78	$252.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $975.88 / $1,097.86 / $1,450.99	Professional		$975.88	$1,097.86	$1,450.99
Providence Facility/Professional Professional Modifier 54 Low / Median / High Price $793.30 / $834.98 / $1,193.96	Professional	54	$793.30	$834.98	$1,193.96
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $198.32 / $208.74 / $298.49	Professional	55	$198.32	$208.74	$298.49
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 $983.43 / $1,058.46 / $1,515.05	Professional		$983.43	$1,058.46	$1,515.05
United Facility/Professional Facility Modifier Low / Median / High Price $1,981.00 / $9,074.00 / $12,113.00	Facility		$1,981.00	$9,074.00	$12,113.00
United Facility/Professional Professional Modifier Low / Median / High Price $780.02 / $1,050.58 / $1,520.19	Professional		$780.02	$1,050.58	$1,520.19