Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $3,715.35 / $5,623.41	Facility		$295.12	$3,715.35	$5,623.41
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $120.23 / $173.78 / $323.59	Facility	53	$120.23	$173.78	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $309.03 / $851.14	Professional		$173.78	$309.03	$851.14
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $60.26 / $125.89 / $234.42	Professional	53	$60.26	$125.89	$234.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $851.14 / $2,290.87	Facility		$851.14	$851.14	$2,290.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $457.09 / $891.25	Professional		$309.03	$457.09	$891.25
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $309.03 / $467.74 / $891.25	Professional	53	$309.03	$467.74	$891.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $389.05 / $812.83	Facility		$181.97	$389.05	$812.83
Moda Health Facility/Professional Facility Modifier 53 Low / Median / High Price $95.50 / $177.83 / $389.05	Facility	53	$95.50	$177.83	$389.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $501.19 / $812.83	Professional		$295.12	$501.19	$812.83
Moda Health Facility/Professional Professional Modifier 53 Low / Median / High Price $72.44 / $138.04 / $275.42	Professional	53	$72.44	$138.04	$275.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $660.69 / $676.08	Facility		$524.81	$660.69	$676.08
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $275.42 / $338.84 / $691.83	Facility	53	$275.42	$338.84	$691.83
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $245.47 / $380.19 / $691.83	Professional	53	$245.47	$380.19	$691.83
Providence Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $371.54 / $741.31	Facility		$177.83	$371.54	$741.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $467.74 / $870.96	Professional		$302.00	$467.74	$870.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,884.03 / $3,548.13	Facility		$2,137.96	$2,884.03	$3,548.13
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Facility	53	$2,398.83	$2,398.83	$2,398.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $549.54 / $851.14	Professional		$346.74	$549.54	$851.14
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $154.88 / $257.04 / $426.58	Professional	53	$154.88	$257.04	$426.58
United Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $2,818.38 / $4,897.79	Facility		$1,096.48	$2,818.38	$4,897.79
United Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $489.78 / $851.14	Professional		$275.42	$489.78	$851.14
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	53	$204.17	$204.17	$204.17