Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $2,818.38 / $5,011.87	Facility		$302.00	$2,818.38	$5,011.87
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $2,187.76 / $3,801.89 / $6,025.60	Facility	50	$2,187.76	$3,801.89	$6,025.60
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility	53	$3,019.95	$3,019.95	$3,019.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $275.42 / $1,096.48	Professional		$104.71	$275.42	$1,096.48
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.25 / $141.25 / $190.55	Professional	22	$141.25	$141.25	$190.55
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $154.88 / $407.38 / $1,445.44	Professional	50	$154.88	$407.38	$1,445.44
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $186.21 / $186.21 / $186.21	Professional	53	$186.21	$186.21	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $199.53 / $512.86	Professional		$109.65	$199.53	$512.86
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $158.49 / $323.59 / $457.09	Professional	50	$158.49	$323.59	$457.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $501.19 / $1,122.02	Facility		$467.74	$501.19	$1,122.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $275.42 / $676.08	Professional		$123.03	$275.42	$676.08
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $281.84 / $831.76	Facility		$138.04	$281.84	$831.76
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $1,905.46 / $3,235.94 / $6,760.83	Facility	50	$1,905.46	$3,235.94	$6,760.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $281.84 / $645.65	Professional		$138.04	$281.84	$645.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $97.72	Professional		$32.36	$33.11	$97.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $446.68 / $501.19	Facility		$302.00	$446.68	$501.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $338.84 / $338.84	Facility		$338.84	$338.84	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $323.59 / $616.60	Professional		$158.49	$323.59	$616.60
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $2,570.40 / $4,897.79	Facility		$1,778.28	$2,570.40	$4,897.79
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $2,630.27 / $3,890.45 / $7,413.10	Facility	50	$2,630.27	$3,890.45	$7,413.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $588.84	Professional		$151.36	$302.00	$588.84
United Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $3,090.30 / $5,011.87	Facility		$891.25	$3,090.30	$5,011.87
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $281.84 / $562.34	Professional		$138.04	$281.84	$562.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $190.55 / $389.05	Professional		$100.00	$190.55	$389.05