Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $117.49 / $117.49	Facility		$112.20	$117.49	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $158.49	Professional		$112.20	$112.20	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $331.13 / $354.81	Facility		$107.15	$331.13	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $138.04	Professional		$112.20	$112.20	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $323.59	Professional		$169.82	$263.03	$323.59
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $141.25 / $218.78	Facility		$112.20	$141.25	$218.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $251.19 / $354.81	Professional		$151.36	$251.19	$354.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $128.82 / $316.23	Facility		$112.20	$128.82	$316.23
Providence Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $134.90 / $691.83	Facility		$112.20	$134.90	$691.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $478.63	Professional		$79.43	$125.89	$478.63
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $158.49 / $812.83	Professional		$125.89	$158.49	$812.83