Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $2,884.03 / $6,456.54	Facility		$177.83	$2,884.03	$6,456.54
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $812.83 / $4,365.16 / $6,606.93	Facility	50	$812.83	$4,365.16	$6,606.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $194.98 / $645.65	Professional		$87.10	$194.98	$645.65
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $131.83 / $302.00 / $1,023.29	Professional	50	$131.83	$302.00	$1,023.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $91.20 / $407.38	Professional		$77.62	$91.20	$407.38
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $120.23 / $245.47 / $416.87	Professional	50	$120.23	$245.47	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $870.96 / $1,348.96	Facility		$501.19	$870.96	$1,348.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $218.78 / $478.63	Professional		$107.15	$218.78	$478.63
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $223.87 / $831.76	Facility		$112.20	$223.87	$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 $112.20 / $223.87 / $562.34	Professional		$112.20	$223.87	$562.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $79.43	Professional		$32.36	$33.11	$79.43
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $331.13 / $354.81	Facility		$234.42	$331.13	$354.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $245.47 / $309.03	Facility		$234.42	$245.47	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $245.47 / $436.52	Professional		$128.82	$245.47	$436.52
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 $120.23 / $239.88 / $416.87	Professional		$120.23	$239.88	$416.87
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 $107.15 / $213.80 / $426.58	Professional		$107.15	$213.80	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $158.49 / $275.42	Professional		$83.18	$158.49	$275.42