Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.95 / $148.41 / $179.09	Facility		$79.95	$148.41	$179.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $66.55 / $87.83	Professional		$45.00	$66.55	$87.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $103.93 / $160.04 / $185.82	Facility		$103.93	$160.04	$185.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.00 / $70.64 / $114.55	Professional		$56.00	$70.64	$114.55
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.96 / $140.62 / $168.51	Professional		$63.96	$140.62	$168.51
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $47.97 / $67.16 / $140.71	Facility		$47.97	$67.16	$140.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.96 / $63.96 / $86.35	Professional		$63.96	$63.96	$86.35
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $63.96 / $67.16 / $141.19	Facility		$63.96	$67.16	$141.19
Providence Facility/Professional Facility Modifier Low / Median / High Price $67.16 / $80.91 / $160.04	Facility		$67.16	$80.91	$160.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.88 / $76.75 / $105.52	Professional		$67.88	$76.75	$105.52
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $124.72 / $194.63 / $251.10	Facility		$124.72	$194.63	$251.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $113.12 / $125.89 / $201.44	Professional		$113.12	$125.89	$201.44
United Facility/Professional Professional Modifier Low / Median / High Price $26.86 / $26.86 / $67.16	Professional		$26.86	$26.86	$67.16