Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $133.50 / $169.14	Facility		$84.53	$133.50	$169.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $85.37 / $118.34	Professional		$84.57	$85.37	$118.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $79.78 / $199.44 / $235.26	Facility		$79.78	$199.44	$235.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $84.57 / $103.72	Professional		$84.57	$84.57	$103.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.54 / $190.72 / $308.94	Professional		$141.54	$190.72	$308.94
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $85.42 / $181.83	Facility		$84.53	$85.42	$181.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $89.65 / $109.94	Professional		$84.57	$89.65	$109.94
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $84.53 / $84.57 / $175.53	Facility		$84.53	$84.57	$175.53
Providence Facility/Professional Facility Modifier Low / Median / High Price $84.57 / $105.72 / $181.83	Facility		$84.57	$105.72	$181.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $134.58 / $146.81	Professional		$84.57	$134.58	$146.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $101.58 / $173.79 / $393.02	Facility		$101.58	$173.79	$393.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $84.57 / $93.03	Professional		$84.57	$84.57	$93.03
United Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $84.57 / $97.26	Professional		$84.57	$84.57	$97.26