Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $490.78 / $490.78 / $490.78	Facility		$490.78	$490.78	$490.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $405.84 / $405.84 / $490.78	Professional		$405.84	$405.84	$490.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $407.96 / $407.96 / $407.96	Facility		$407.96	$407.96	$407.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.33 / $346.77 / $407.96	Professional		$64.33	$346.77	$407.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,422.14 / $1,450.71 / $1,573.46	Professional		$1,422.14	$1,450.71	$1,573.46
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $103.12 / $426.13 / $1,196.07	Facility		$103.12	$426.13	$1,196.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $75.08 / $610.44 / $813.95	Professional		$75.08	$610.44	$813.95
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $919.05 / $1,016.57 / $1,119.57	Facility		$919.05	$1,016.57	$1,119.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $919.05 / $1,103.90 / $1,119.57	Professional		$919.05	$1,103.90	$1,119.57
Providence Facility/Professional Facility Modifier Low / Median / High Price $103.12 / $426.13 / $1,484.04	Facility		$103.12	$426.13	$1,484.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.33 / $77.62 / $407.96	Professional		$64.33	$77.62	$407.96
United Facility/Professional Professional Modifier Low / Median / High Price $361.84 / $361.84 / $603.05	Professional		$361.84	$361.84	$603.05