Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $407.38 / $1,000.00 / $13,803.84	Facility		$407.38	$1,000.00	$13,803.84
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Facility	50	$1,949.84	$1,949.84	$1,949.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $338.84 / $1,202.26	Professional		$208.93	$338.84	$1,202.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $331.13 / $524.81 / $1,995.26	Professional	50	$331.13	$524.81	$1,995.26
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $165.96 / $165.96 / $501.19	Professional	54	$165.96	$165.96	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $524.81	Professional		$199.53	$234.42	$524.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $309.03 / $478.63	Facility		$309.03	$309.03	$478.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $389.05 / $724.44	Professional		$245.47	$389.05	$724.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $416.87 / $707.95	Facility		$169.82	$416.87	$707.95
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $1,445.44 / $2,344.23 / $4,168.69	Facility	50	$1,445.44	$2,344.23	$4,168.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $416.87 / $616.60	Professional		$169.82	$416.87	$616.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $158.49	Professional		$32.36	$33.11	$158.49
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $478.63 / $512.86	Facility		$380.19	$478.63	$512.86
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $323.59 / $331.13	Facility		$165.96	$323.59	$331.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $478.63 / $630.96	Professional		$288.40	$478.63	$630.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,659.59 / $3,162.28	Facility		$1,202.26	$1,659.59	$3,162.28
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $1,778.28 / $2,454.71 / $4,677.35	Facility	50	$1,778.28	$2,454.71	$4,677.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $645.65	Professional		$331.13	$467.74	$645.65
United Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $1,905.46 / $4,365.16	Facility		$398.11	$1,905.46	$4,365.16
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $380.19 / $630.96	Professional		$263.03	$380.19	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $288.40 / $478.63	Professional		$32.36	$288.40	$478.63