Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $5,623.41 / $13,489.63	Facility		$794.33	$5,623.41	$13,489.63
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Facility	22	$4,073.80	$4,073.80	$4,073.80
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $28,840.32 / $28,840.32 / $28,840.32	Facility	50	$28,840.32	$28,840.32	$28,840.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $831.76 / $3,162.28	Professional		$524.81	$831.76	$3,162.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $1,023.29 / $1,584.89	Professional		$549.54	$1,023.29	$1,584.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $758.58 / $2,630.27	Facility		$630.96	$758.58	$2,630.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $1,000.00 / $1,862.09	Professional		$537.03	$1,000.00	$1,862.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $1,174.90 / $2,454.71	Facility		$645.65	$1,174.90	$2,454.71
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $4,786.30 / $7,943.28 / $14,125.38	Facility	50	$4,786.30	$7,943.28	$14,125.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $1,122.02 / $1,737.80	Professional		$575.44	$1,122.02	$1,737.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $281.84	Professional		$32.36	$33.11	$281.84
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $1,148.15 / $1,230.27	Facility		$831.76	$1,148.15	$1,230.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $812.83 / $831.76	Facility		$812.83	$812.83	$831.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,318.26 / $1,778.28	Professional		$831.76	$1,318.26	$1,778.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $5,495.41 / $10,471.29	Facility		$3,890.45	$5,495.41	$10,471.29
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $5,888.44 / $8,128.31 / $15,848.93	Facility	50	$5,888.44	$8,128.31	$15,848.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,148.15 / $1,548.82	Professional		$831.76	$1,148.15	$1,548.82
United Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $6,760.83 / $11,220.18	Facility		$1,995.26	$6,760.83	$11,220.18
United Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $870.96 / $1,621.81	Professional		$602.56	$870.96	$1,621.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $676.08 / $1,096.48	Professional		$588.84	$676.08	$1,096.48