Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $478.63 / $1,412.54	Facility		$257.04	$478.63	$1,412.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $501.19	Professional		$154.88	$239.88	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Professional		$158.49	$158.49	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $588.84 / $831.76	Facility		$269.15	$588.84	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $288.40 / $398.11	Professional		$162.18	$288.40	$398.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $363.08 / $794.33	Facility		$257.04	$363.08	$794.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $794.33	Professional		$257.04	$363.08	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $75.86 / $75.86	Professional		$64.57	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $489.78	Facility		$257.04	$257.04	$489.78
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $446.68 / $776.25	Facility		$257.04	$446.68	$776.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $229.09 / $309.03	Professional		$229.09	$229.09	$309.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $389.05 / $707.95	Facility		$269.15	$389.05	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $229.09 / $302.00	Professional		$218.78	$229.09	$302.00
United Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $309.03 / $309.03	Facility		$257.04	$309.03	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $309.03	Professional		$107.15	$147.91	$309.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $257.04 / $467.74	Professional		$114.82	$257.04	$467.74