Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $1,412.54 / $12,882.50	Facility		$218.78	$1,412.54	$12,882.50
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,466.84 / $4,677.35 / $18,620.87	Facility	50	$4,466.84	$4,677.35	$18,620.87
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $407.38 / $1,288.25	Professional	50	$147.91	$407.38	$1,288.25
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $257.04 / $257.04 / $302.00	Professional	50	$257.04	$257.04	$302.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $288.40 / $602.56	Facility		$147.91	$288.40	$602.56
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $467.74 / $489.78	Facility		$346.74	$467.74	$489.78
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $316.23 / $331.13	Facility		$316.23	$316.23	$331.13
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $660.69 / $6,165.95	Facility		$416.87	$660.69	$6,165.95