Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,412.54 / $6,456.54 / $20,892.96	Facility		$1,412.54	$6,456.54	$20,892.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,202.26 / $3,981.07	Professional		$758.58	$1,202.26	$3,981.07
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $169.82 / $489.78 / $912.01	Professional	AS	$169.82	$489.78	$912.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,348.96 / $1,548.82	Professional		$794.33	$1,348.96	$1,548.82
Ambetter Facility/Professional Professional Modifier AS Low / Median / High Price $107.15 / $194.98 / $234.42	Professional	AS	$107.15	$194.98	$234.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $2,630.27 / $4,677.35	Facility		$645.65	$2,630.27	$4,677.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,584.89 / $2,884.03	Professional		$1,047.13	$1,584.89	$2,884.03
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $2,089.30 / $5,011.87	Facility		$1,288.25	$2,089.30	$5,011.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $2,041.74 / $3,090.30	Professional		$1,288.25	$2,041.74	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $371.54	Professional		$32.36	$33.11	$371.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,089.30 / $2,187.76	Facility		$1,513.56	$2,089.30	$2,187.76
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $1,445.44 / $1,479.11	Facility		$1,445.44	$1,445.44	$1,479.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $2,041.74 / $2,754.23	Professional		$1,202.26	$2,041.74	$2,754.23
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $6,760.83 / $10,232.93 / $19,498.45	Facility		$6,760.83	$10,232.93	$19,498.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,698.24 / $2,344.23	Professional		$1,174.90	$1,698.24	$2,344.23
United Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $12,022.64 / $20,417.38	Facility		$2,137.96	$12,022.64	$20,417.38
United Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,479.11 / $2,818.38	Professional		$1,122.02	$1,479.11	$2,818.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,148.15 / $1,621.81	Professional		$776.25	$1,148.15	$1,621.81