Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $142.86 / $142.86 / $142.86	Facility		$142.86	$142.86	$142.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.90 / $131.90 / $404.53	Professional		$131.90	$131.90	$404.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $124.43 / $204.29 / $267.32	Facility		$124.43	$204.29	$267.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.90 / $131.90 / $155.54	Professional		$131.90	$131.90	$155.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $239.70 / $331.52 / $413.12	Professional		$239.70	$331.52	$413.12
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $131.90 / $142.86 / $283.58	Facility		$131.90	$142.86	$283.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.90 / $139.81 / $171.47	Professional		$131.90	$139.81	$171.47
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $131.90 / $148.97 / $274.35	Facility		$131.90	$148.97	$274.35
Providence Facility/Professional Facility Modifier Low / Median / High Price $131.90 / $166.99 / $288.72	Facility		$131.90	$166.99	$288.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.90 / $172.08 / $197.77	Professional		$131.90	$172.08	$197.77
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.31 / $131.90 / $131.90	Professional		$125.31	$131.90	$131.90
United Facility/Professional Professional Modifier Low / Median / High Price $131.90 / $131.90 / $151.69	Professional		$131.90	$131.90	$151.69