Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $79.80 / $168.56	Facility		$79.80	$79.80	$168.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.72 / $69.72 / $79.80	Professional		$69.72	$69.72	$79.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $142.80 / $142.80 / $142.80	Facility		$142.80	$142.80	$142.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $71.40 / $71.40	Professional		$71.40	$71.40	$71.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $126.51 / $145.91 / $157.44	Professional		$126.51	$145.91	$157.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $69.72 / $92.40 / $149.90	Facility		$69.72	$92.40	$149.90
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79.80 / $80.40 / $134.00	Facility		$79.80	$80.40	$134.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $69.72 / $99.75 / $159.60	Facility		$69.72	$99.75	$159.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $99.75 / $126.91	Professional		$71.40	$99.75	$126.91
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $79.80 / $79.80	Professional		$79.80	$79.80	$79.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.80 / $79.80 / $91.77	Professional		$79.80	$79.80	$91.77