Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Facility		$758.58	$758.58	$758.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $691.83 / $1,148.15	Professional		$549.54	$691.83	$1,148.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $724.44 / $724.44	Facility		$724.44	$724.44	$724.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $524.81	Professional		$524.81	$524.81	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $2,511.89 / $3,090.30	Professional		$977.24	$2,511.89	$3,090.30
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $954.99 / $1,288.25	Facility		$758.58	$954.99	$1,288.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,023.29 / $1,380.38	Professional		$933.25	$1,023.29	$1,380.38
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,258.93 / $1,318.26	Facility		$1,230.27	$1,258.93	$1,318.26
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,258.93	Professional		$1,000.00	$1,000.00	$1,258.93
Providence Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $1,096.48 / $1,995.26	Facility		$724.44	$1,096.48	$1,995.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $1,096.48 / $1,318.26	Professional		$79.43	$1,096.48	$1,318.26
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,778.28 / $4,897.79	Facility		$1,047.13	$1,778.28	$4,897.79
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,412.54 / $1,412.54	Professional		$1,288.25	$1,412.54	$1,412.54
United Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $1,905.46 / $2,511.89	Facility		$575.44	$1,905.46	$2,511.89
United Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $575.44 / $1,096.48	Professional		$524.81	$575.44	$1,096.48