Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.75 / $64.75 / $64.75	Facility		$64.75	$64.75	$64.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.97 / $106.97 / $115.53	Professional		$106.97	$106.97	$115.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.75 / $75.73 / $100.91	Facility		$53.75	$75.73	$100.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.97 / $106.97 / $121.10	Professional		$106.97	$106.97	$121.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $99.57 / $136.78 / $164.55	Professional		$99.57	$136.78	$164.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $64.75 / $106.97 / $228.92	Facility		$64.75	$106.97	$228.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $106.97 / $113.39 / $139.06	Professional		$106.97	$113.39	$139.06
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $42.74 / $106.97 / $222.01	Facility		$42.74	$106.97	$222.01
Providence Facility/Professional Facility Modifier Low / Median / High Price $47.48 / $106.97 / $167.79	Facility		$47.48	$106.97	$167.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.48 / $106.97 / $121.53	Professional		$47.48	$106.97	$121.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $101.62 / $106.97 / $106.97	Professional		$101.62	$106.97	$106.97
United Facility/Professional Professional Modifier Low / Median / High Price $106.97 / $106.97 / $123.02	Professional		$106.97	$106.97	$123.02