Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $524.81 / $1,000.00	Facility		$295.12	$524.81	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $288.40 / $1,023.29	Professional		$213.80	$288.40	$1,023.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $489.78 / $794.33	Professional		$30.20	$489.78	$794.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $295.12 / $295.12	Facility		$173.78	$295.12	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $295.12	Professional		$213.80	$213.80	$295.12
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $645.65 / $1,288.25	Facility		$275.42	$645.65	$1,288.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $562.34 / $1,000.00	Professional		$275.42	$562.34	$1,000.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $316.23 / $389.05	Professional		$34.67	$316.23	$389.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $446.68 / $457.09	Facility		$363.08	$446.68	$457.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $457.09 / $457.09	Professional		$407.38	$457.09	$457.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $676.08 / $977.24	Facility		$398.11	$676.08	$977.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $524.81	Professional		$380.19	$380.19	$524.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $446.68 / $446.68	Facility		$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $398.11 / $512.86	Professional		$380.19	$398.11	$512.86
United Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $707.95 / $707.95	Facility		$213.80	$707.95	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $251.19 / $416.87	Professional		$204.17	$251.19	$416.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $323.59 / $691.83	Professional		$269.15	$323.59	$691.83