Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $302.00 / $891.25	Facility		$275.42	$302.00	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $426.58 / $794.33	Professional		$223.87	$426.58	$794.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $524.81 / $549.54	Professional		$489.78	$524.81	$549.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $467.74 / $489.78	Facility		$467.74	$467.74	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $338.84 / $489.78	Professional		$338.84	$338.84	$489.78
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $1,023.29 / $2,089.30	Facility		$436.52	$1,023.29	$2,089.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $977.24 / $1,288.25	Professional		$436.52	$977.24	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $524.81 / $575.44	Professional		$467.74	$524.81	$575.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $446.68 / $616.60	Facility		$446.68	$446.68	$616.60
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Professional		$549.54	$549.54	$549.54
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $645.65 / $954.99	Facility		$467.74	$645.65	$954.99
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $512.86	Professional		$363.08	$363.08	$512.86
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $426.58	Facility		$426.58	$426.58	$426.58
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $537.03	Professional		$389.05	$389.05	$537.03
United Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $1,318.26 / $1,318.26	Facility		$338.84	$1,318.26	$1,318.26
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $346.74 / $575.44	Professional		$323.59	$346.74	$575.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $389.05 / $676.08	Professional		$316.23	$389.05	$676.08