Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $316.23 / $1,000.00	Facility		$199.53	$316.23	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $263.03 / $309.03	Professional		$58.88	$263.03	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $5.62 / $5.62 / $398.11	Professional		$5.62	$5.62	$398.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $275.42 / $549.54	Facility		$275.42	$275.42	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $162.18 / $870.96	Facility		$67.61	$162.18	$870.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $630.96 / $870.96	Professional		$85.11	$630.96	$870.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $338.84	Professional		$32.36	$33.11	$338.84
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $794.33	Facility		$302.00	$302.00	$794.33
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Professional		$302.00	$302.00	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $323.59	Professional		$269.15	$269.15	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $426.58	Professional		$302.00	$398.11	$426.58