Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $489.78 / $707.95	Facility		$208.93	$489.78	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $177.83 / $398.11	Professional		$109.65	$177.83	$398.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $537.03	Professional		$537.03	$537.03	$537.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $177.83 / $181.97	Facility		$112.20	$177.83	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $181.97	Professional		$128.82	$128.82	$181.97
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $446.68 / $870.96	Facility		$177.83	$446.68	$870.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $398.11 / $660.69	Professional		$177.83	$398.11	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $213.80 / $263.03	Professional		$23.44	$213.80	$263.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $302.00 / $323.59	Facility		$245.47	$302.00	$323.59
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $309.03 / $323.59	Professional		$275.42	$309.03	$323.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $457.09 / $660.69	Facility		$269.15	$457.09	$660.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $338.84	Professional		$257.04	$257.04	$338.84
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 $257.04 / $269.15 / $346.74	Professional		$257.04	$269.15	$346.74
United Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $457.09 / $457.09	Facility		$141.25	$457.09	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $151.36 / $269.15	Professional		$131.83	$151.36	$269.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $218.78 / $467.74	Professional		$169.82	$218.78	$467.74