Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $168.13 / $211.49 / $329.18	Facility		$168.13	$211.49	$329.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $169.81 / $445.69	Professional		$164.59	$169.81	$445.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $155.27 / $234.75 / $326.60	Facility		$155.27	$234.75	$326.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $164.59 / $178.56	Professional		$164.59	$164.59	$178.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $369.32 / $436.60	Professional		$164.59	$369.32	$436.60
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $164.59 / $235.36 / $353.87	Facility		$164.59	$235.36	$353.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $175.84 / $213.97	Professional		$164.59	$175.84	$213.97
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $164.59 / $210.16 / $349.71	Facility		$164.59	$210.16	$349.71
Providence Facility/Professional Facility Modifier Low / Median / High Price $164.59 / $234.75 / $353.87	Facility		$164.59	$234.75	$353.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $198.38 / $213.20	Professional		$164.59	$198.38	$213.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $164.59 / $189.28 / $504.57	Facility		$164.59	$189.28	$504.57
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $164.59 / $164.59	Professional		$164.59	$164.59	$164.59
United Facility/Professional Professional Modifier Low / Median / High Price $164.59 / $164.59 / $197.51	Professional		$164.59	$164.59	$197.51