Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $4,073.80 / $18,620.87	Facility		$602.56	$4,073.80	$18,620.87
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $6,918.31 / $29,512.09 / $31,622.78	Facility	50	$6,918.31	$29,512.09	$31,622.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $1,096.48 / $3,162.28	Professional		$309.03	$1,096.48	$3,162.28
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $245.47 / $1,047.13 / $5,754.40	Professional	50	$245.47	$1,047.13	$5,754.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $371.54 / $371.54 / $371.54	Professional	50	$371.54	$371.54	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $1,047.13 / $4,168.69	Professional		$371.54	$1,047.13	$4,168.69
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $1,819.70 / $4,897.79	Facility		$446.68	$1,819.70	$4,897.79
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $8,128.31 / $19,952.62 / $40,738.03	Facility	50	$8,128.31	$19,952.62	$40,738.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $1,047.13 / $3,801.89	Professional		$398.11	$1,047.13	$3,801.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $204.17	Professional		$32.36	$33.11	$204.17
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $3,090.30 / $3,311.31	Facility		$2,137.96	$3,090.30	$3,311.31
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $2,290.87	Facility		$2,238.72	$2,238.72	$2,290.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $2,089.30 / $4,365.16	Professional		$501.19	$2,089.30	$4,365.16
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,715.19 / $15,488.17 / $29,512.09	Facility		$10,715.19	$15,488.17	$29,512.09
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $15,848.93 / $23,442.29 / $44,668.36	Facility	50	$15,848.93	$23,442.29	$44,668.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $1,230.27 / $3,630.78	Professional		$524.81	$1,230.27	$3,630.78
United Facility/Professional Facility Modifier Low / Median / High Price $4,677.35 / $19,498.45 / $33,113.11	Facility		$4,677.35	$19,498.45	$33,113.11
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $1,513.56 / $3,715.35	Professional		$380.19	$1,513.56	$3,715.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $549.54 / $2,818.38	Professional		$288.40	$549.54	$2,818.38