Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $1,445.44 / $5,888.44	Facility		$870.96	$1,445.44	$5,888.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $707.95 / $2,754.23	Professional		$575.44	$707.95	$2,754.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $707.95 / $1,659.59	Professional		$512.86	$707.95	$1,659.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,258.93 / $1,949.84	Professional		$794.33	$1,258.93	$1,949.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $1,288.25 / $1,621.81	Facility		$758.58	$1,288.25	$1,621.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,348.96 / $1,737.80	Professional		$812.83	$1,348.96	$1,737.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,230.27 / $1,288.25	Facility		$1,023.29	$1,230.27	$1,288.25
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $851.14 / $870.96	Facility		$851.14	$851.14	$870.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,445.44 / $1,905.46	Professional		$870.96	$1,445.44	$1,905.46
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $870.96 / $870.96	Facility		$870.96	$870.96	$870.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,348.96 / $1,819.70	Professional		$870.96	$1,348.96	$1,819.70
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $831.76 / $1,659.59	Professional		$588.84	$831.76	$1,659.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $870.96 / $1,230.27	Professional		$645.65	$870.96	$1,230.27