Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $398.11 / $933.25	Facility		$398.11	$398.11	$933.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $676.08	Professional		$269.15	$363.08	$676.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Facility		$457.09	$457.09	$457.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $338.84 / $457.09	Professional		$338.84	$338.84	$457.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $912.01 / $1,737.80	Facility		$380.19	$912.01	$1,737.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $776.25 / $1,412.54	Professional		$380.19	$776.25	$1,412.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $467.74 / $512.86	Professional		$75.86	$467.74	$512.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $588.84 / $602.56	Facility		$478.63	$588.84	$602.56
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $602.56 / $602.56	Professional		$549.54	$602.56	$602.56
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $891.25 / $1,288.25	Facility		$537.03	$891.25	$1,288.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $691.83	Professional		$501.19	$501.19	$691.83
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $588.84 / $588.84	Facility		$588.84	$588.84	$588.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $524.81 / $676.08	Professional		$501.19	$524.81	$676.08
United Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $1,000.00 / $1,000.00	Facility		$363.08	$1,000.00	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $407.38 / $575.44	Professional		$281.84	$407.38	$575.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $524.81 / $933.25	Professional		$436.52	$524.81	$933.25