Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $223.87 / $18,620.87	Facility		$151.36	$223.87	$18,620.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $281.84	Professional		$79.43	$120.23	$281.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $11.48 / $281.84 / $870.96	Professional	50	$11.48	$281.84	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $151.36 / $281.84	Professional		$89.13	$151.36	$281.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $173.78 / $309.03	Facility		$112.20	$173.78	$309.03
Kaiser Permanente Facility/Professional Facility Modifier 50 Low / Median / High Price $1,023.29 / $1,698.24 / $2,951.21	Facility	50	$1,023.29	$1,698.24	$2,951.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $251.19	Professional		$112.20	$173.78	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $186.21 / $204.17	Facility		$141.25	$186.21	$204.17
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $131.83	Facility		$128.82	$128.82	$131.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $186.21 / $239.88	Professional		$112.20	$186.21	$239.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $1,122.02 / $2,137.96	Facility		$776.25	$1,122.02	$2,137.96
Regence BlueShield Facility/Professional Facility Modifier 50 Low / Median / High Price $257.04 / $257.04 / $323.59	Facility	50	$257.04	$257.04	$323.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $181.97 / $251.19	Professional		$131.83	$181.97	$251.19
United Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $1,548.82 / $3,548.13	Facility		$154.88	$1,548.82	$3,548.13
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $141.25 / $239.88	Professional		$100.00	$141.25	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $112.20 / $186.21	Professional		$12.88	$112.20	$186.21