Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $91.20 / $151.36	Facility		$57.54	$91.20	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $60.26 / $107.15	Professional		$57.54	$60.26	$107.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $138.04 / $162.18	Facility		$54.95	$138.04	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $63.10	Professional		$57.54	$57.54	$63.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $97.72 / $114.82	Professional		$44.67	$97.72	$114.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $61.66 / $144.54	Facility		$57.54	$61.66	$144.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $63.10 / $204.17	Professional		$57.54	$63.10	$204.17
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $79.43 / $154.88	Facility		$63.10	$79.43	$154.88
Providence Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $138.04 / $295.12	Facility		$57.54	$138.04	$295.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $69.18 / $158.49	Professional		$50.12	$69.18	$158.49
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $257.04 / $588.84	Facility		$162.18	$257.04	$588.84
United Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $57.54 / $138.04	Facility		$57.54	$57.54	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $64.57	Professional		$57.54	$57.54	$64.57