Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,398.83 / $19,054.61 / $60,255.96	Facility		$2,398.83	$19,054.61	$60,255.96
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $26,302.68 / $26,302.68 / $26,302.68	Facility	22	$26,302.68	$26,302.68	$26,302.68
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $31,622.78 / $31,622.78 / $31,622.78	Facility	50	$31,622.78	$31,622.78	$31,622.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,778.28 / $7,943.28	Professional		$831.76	$1,778.28	$7,943.28
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $165.96 / $389.05 / $977.24	Professional	AS	$165.96	$389.05	$977.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $1,258.93 / $2,570.40	Professional		$204.17	$1,258.93	$2,570.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $870.96 / $26,302.68	Facility		$758.58	$870.96	$26,302.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $2,089.30 / $3,890.45	Professional		$1,288.25	$2,089.30	$3,890.45
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $2,818.38 / $23,988.33	Facility		$1,621.81	$2,818.38	$23,988.33
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $20,892.96 / $38,904.51 / $61,659.50	Facility	50	$20,892.96	$38,904.51	$61,659.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $2,630.27 / $16,982.44	Professional		$1,584.89	$2,630.27	$16,982.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $575.44	Professional		$32.36	$33.11	$575.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $2,511.89 / $2,630.27	Facility		$2,137.96	$2,511.89	$2,630.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,778.28 / $6,456.54	Facility		$1,737.80	$1,778.28	$6,456.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,754.23 / $3,715.35	Professional		$1,778.28	$2,754.23	$3,715.35
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $28,183.83 / $37,153.52 / $70,794.58	Facility		$28,183.83	$37,153.52	$70,794.58
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $42,657.95 / $54,954.09 / $107,151.93	Facility	50	$42,657.95	$54,954.09	$107,151.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $2,454.71 / $3,388.44	Professional		$1,737.80	$2,454.71	$3,388.44
United Facility/Professional Facility Modifier Low / Median / High Price $6,309.57 / $38,018.94 / $72,443.60	Facility		$6,309.57	$38,018.94	$72,443.60
United Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $2,089.30 / $3,630.78	Professional		$1,412.54	$2,089.30	$3,630.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,318.26 / $2,187.76	Professional		$1,148.15	$1,318.26	$2,187.76