Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $416.87 / $1,445.44	Facility		$245.47	$416.87	$1,445.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $208.93 / $389.05	Professional		$169.82	$208.93	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $602.56 / $758.58	Facility		$275.42	$602.56	$758.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $275.42 / $354.81	Professional		$138.04	$275.42	$354.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $316.23 / $691.83	Facility		$263.03	$316.23	$691.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $331.13 / $724.44	Professional		$263.03	$331.13	$724.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $263.03 / $501.19	Facility		$263.03	$263.03	$501.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $457.09 / $794.33	Facility		$263.03	$457.09	$794.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $316.23	Professional		$234.42	$234.42	$316.23
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $398.11 / $724.44	Facility		$275.42	$398.11	$724.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $234.42 / $295.12	Professional		$223.87	$234.42	$295.12
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $316.23 / $316.23	Facility		$263.03	$316.23	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $316.23	Professional		$109.65	$123.03	$316.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $263.03 / $478.63	Professional		$117.49	$263.03	$478.63