Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $3,090.30 / $8,511.38	Facility		$234.42	$3,090.30	$8,511.38
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $74.13 / $147.91 / $263.03	Facility	53	$74.13	$147.91	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $954.99	Professional		$165.96	$295.12	$954.99
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $64.57 / $120.23 / $234.42	Professional	53	$64.57	$120.23	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $478.63	Professional		$165.96	$309.03	$478.63
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $134.90 / $134.90 / $239.88	Professional	53	$134.90	$134.90	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $741.31 / $1,380.38	Facility		$630.96	$741.31	$1,380.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $107.15 / $147.91 / $269.15	Professional	53	$107.15	$147.91	$269.15
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $512.86 / $1,047.13	Facility		$269.15	$512.86	$1,047.13
Kaiser Permanente Facility/Professional Facility Modifier 53 Low / Median / High Price $87.10 / $199.53 / $426.58	Facility	53	$87.10	$199.53	$426.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $436.52 / $870.96	Professional		$229.09	$436.52	$870.96
Kaiser Permanente Facility/Professional Professional Modifier 53 Low / Median / High Price $87.10 / $190.55 / $380.19	Professional	53	$87.10	$190.55	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $660.69 / $676.08	Facility		$562.34	$660.69	$676.08
Pacific Source Facility/Professional Facility Modifier 53 Low / Median / High Price $275.42 / $338.84 / $691.83	Facility	53	$275.42	$338.84	$691.83
Pacific Source Facility/Professional Professional Modifier 53 Low / Median / High Price $245.47 / $398.11 / $724.44	Professional	53	$245.47	$398.11	$724.44
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $467.74 / $707.95	Facility		$467.74	$467.74	$707.95
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $467.74 / $891.25	Professional		$257.04	$467.74	$891.25
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 53 Low / Median / High Price $1,548.82 / $1,548.82 / $1,548.82	Facility	53	$1,548.82	$1,548.82	$1,548.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $467.74 / $724.44	Professional		$251.19	$467.74	$724.44
Regence BlueShield Facility/Professional Professional Modifier 53 Low / Median / High Price $125.89 / $234.42 / $363.08	Professional	53	$125.89	$234.42	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $2,884.03 / $5,248.07	Facility		$602.56	$2,884.03	$5,248.07
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $380.19 / $676.08	Professional		$213.80	$380.19	$676.08
United Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $204.17 / $204.17	Professional	53	$204.17	$204.17	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $446.68 / $741.31	Professional		$389.05	$446.68	$741.31
Wellpoint Facility/Professional Professional Modifier 53 Low / Median / High Price $194.98 / $223.87 / $371.54	Professional	53	$194.98	$223.87	$371.54