Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $785.18 / $12,274.80 / $21,735.00	Facility		$785.18	$12,274.80	$21,735.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $557.59 / $557.59 / $619.92	Facility	52	$557.59	$557.59	$619.92
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $223.03 / $223.03 / $247.97	Facility	53	$223.03	$223.03	$247.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $805.72 / $1,139.55 / $1,297.23	Professional		$805.72	$1,139.55	$1,297.23
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $494.18 / $912.85 / $1,372.47	Facility		$494.18	$912.85	$1,372.47
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $721.87 / $981.52 / $1,050.59	Facility		$721.87	$981.52	$1,050.59
Providence Facility/Professional Facility Modifier Low / Median / High Price $494.18 / $995.52 / $1,372.47	Facility		$494.18	$995.52	$1,372.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $13,963.09 / $17,821.54 / $22,636.72	Facility		$13,963.09	$17,821.54	$22,636.72
United Facility/Professional Facility Modifier Low / Median / High Price $3,028.00 / $17,375.00 / $23,587.00	Facility		$3,028.00	$17,375.00	$23,587.00