Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $313.00 / $2,747.00 / $6,072.60	Facility		$313.00	$2,747.00	$6,072.60
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $82.29 / $82.29 / $150.58	Facility	52	$82.29	$82.29	$150.58
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $60.23 / $179.18 / $333.37	Facility	53	$60.23	$179.18	$333.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.09 / $291.93 / $774.03	Professional		$180.09	$291.93	$774.03
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $44.25 / $103.87 / $276.31	Professional	53	$44.25	$103.87	$276.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $842.71 / $842.71 / $2,310.00	Facility		$842.71	$842.71	$2,310.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $301.75	Professional		$301.75	$301.75	$301.75
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $345.01 / $496.35 / $826.26	Professional		$345.01	$496.35	$826.26
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $345.93 / $514.42 / $826.26	Professional	53	$345.93	$514.42	$826.26
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $239.09 / $466.62 / $840.14	Facility		$239.09	$466.62	$840.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $315.52 / $541.17 / $815.48	Professional		$315.52	$541.17	$815.48
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $359.12 / $662.81 / $739.54	Facility		$359.12	$662.81	$739.54
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $278.58 / $376.26 / $702.44	Facility	53	$278.58	$376.26	$702.44
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $243.45 / $397.98 / $713.29	Professional	53	$243.45	$397.98	$713.29
Providence Facility/Professional Facility Modifier Low / Median / High Price $239.09 / $470.90 / $958.23	Facility		$239.09	$470.90	$958.23
Providence Facility/Professional Professional Modifier Low / Median / High Price $343.54 / $539.65 / $886.89	Professional		$343.54	$539.65	$886.89
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,153.07 / $2,975.12 / $3,619.70	Facility		$2,153.07	$2,975.12	$3,619.70
Regence BlueShield Facility/Professional Facility Modifier 53 Low / Median / High Price $2,392.77 / $2,392.77 / $2,392.77	Facility	53	$2,392.77	$2,392.77	$2,392.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $309.51 / $552.33 / $918.00	Professional		$309.51	$552.33	$918.00
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $155.04 / $276.17 / $452.65	Professional	53	$155.04	$276.17	$452.65
United Facility/Professional Facility Modifier Low / Median / High Price $1,096.00 / $2,261.00 / $4,911.00	Facility		$1,096.00	$2,261.00	$4,911.00
United Facility/Professional Professional Modifier Low / Median / High Price $480.92 / $732.16 / $1,085.18	Professional		$480.92	$732.16	$1,085.18
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.84 / $204.84 / $204.84	Professional	53	$204.84	$204.84	$204.84