Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $130.26 / $130.26 / $130.26	Facility		$130.26	$130.26	$130.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $128.94	Professional		$111.15	$111.15	$128.94
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.86 / $514.79 / $664.84	Facility		$104.86	$514.79	$664.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $131.08	Professional		$111.15	$111.15	$131.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.54 / $317.88 / $1,042.08	Professional		$218.54	$317.88	$1,042.08
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $130.26 / $521.40	Facility		$111.15	$130.26	$521.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $117.82 / $144.50	Professional		$111.15	$117.82	$144.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $130.26 / $333.45	Facility		$111.15	$130.26	$333.45
Providence Facility/Professional Facility Modifier Low / Median / High Price $111.15 / $210.29 / $521.40	Facility		$111.15	$210.29	$521.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $436.55 / $475.54	Professional		$111.15	$436.55	$475.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $105.59 / $111.15 / $111.15	Professional		$105.59	$111.15	$111.15
United Facility/Professional Professional Modifier Low / Median / High Price $111.15 / $111.15 / $127.82	Professional		$111.15	$111.15	$127.82