Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,284.73 / $14,614.14 / $23,856.49	Facility		$1,284.73	$14,614.14	$23,856.49
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $301.35 / $301.35 / $337.58	Facility	53	$301.35	$301.35	$337.58
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,130.06 / $1,130.06 / $1,265.94	Facility	54	$1,130.06	$1,130.06	$1,265.94
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $226.01 / $226.01 / $253.19	Facility	55	$226.01	$226.01	$253.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.94 / $782.21 / $1,506.74	Professional		$584.94	$782.21	$1,506.74
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $75.70 / $153.04 / $266.77	Professional	55	$75.70	$153.04	$266.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $691.00 / $691.00 / $691.00	Facility		$691.00	$691.00	$691.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $731.80 / $1,165.01 / $1,817.34	Professional		$731.80	$1,165.01	$1,817.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $687.87 / $1,432.90 / $1,592.11	Professional		$687.87	$1,432.90	$1,592.11
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $687.87 / $1,044.50 / $1,727.23	Facility		$687.87	$1,044.50	$1,727.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,083.44 / $1,260.73 / $2,153.75	Professional		$1,083.44	$1,260.73	$2,153.75
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $815.26 / $1,270.59 / $1,358.76	Facility		$815.26	$1,270.59	$1,358.76
Providence Facility/Professional Facility Modifier Low / Median / High Price $711.33 / $1,313.40 / $1,721.35	Facility		$711.33	$1,313.40	$1,721.35
Providence Facility/Professional Facility Modifier 53 Low / Median / High Price $151.22 / $151.22 / $151.22	Facility	53	$151.22	$151.22	$151.22
Providence Facility/Professional Facility Modifier 54 Low / Median / High Price $529.26 / $1,268.74 / $1,268.74	Facility	54	$529.26	$1,268.74	$1,268.74
Providence Facility/Professional Facility Modifier 55 Low / Median / High Price $113.41 / $317.19 / $317.19	Facility	55	$113.41	$317.19	$317.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,167.23 / $1,323.25 / $1,823.17	Professional		$1,167.23	$1,323.25	$1,823.17
Providence Facility/Professional Professional Modifier 55 Low / Median / High Price $248.85 / $262.68 / $347.60	Professional	55	$248.85	$262.68	$347.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $11,594.94 / $14,524.38 / $20,699.53	Facility		$11,594.94	$14,524.38	$20,699.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,233.75 / $1,298.68 / $1,825.06	Professional		$1,233.75	$1,298.68	$1,825.06
United Facility/Professional Facility Modifier Low / Median / High Price $2,912.00 / $17,192.00 / $22,956.00	Facility		$2,912.00	$17,192.00	$22,956.00
United Facility/Professional Professional Modifier Low / Median / High Price $888.74 / $1,303.50 / $2,114.33	Professional		$888.74	$1,303.50	$2,114.33