Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $436.52 / $549.54	Facility		$229.09	$436.52	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $199.53 / $389.05	Professional		$147.91	$199.53	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $275.42	Professional		$269.15	$269.15	$275.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $208.93 / $208.93	Facility		$208.93	$208.93	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $208.93	Professional		$151.36	$151.36	$208.93
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $501.19 / $1,023.29	Facility		$208.93	$501.19	$1,023.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $436.52 / $776.25	Professional		$208.93	$436.52	$776.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $275.42 / $302.00	Professional		$75.86	$275.42	$302.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $331.13 / $354.81	Facility		$281.84	$331.13	$354.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $354.81 / $354.81	Professional		$323.59	$354.81	$354.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $524.81 / $758.58	Facility		$309.03	$524.81	$758.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $389.05	Professional		$295.12	$295.12	$389.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $346.74 / $346.74	Facility		$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $309.03 / $398.11	Professional		$295.12	$309.03	$398.11
United Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $549.54 / $549.54	Facility		$173.78	$549.54	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $223.87 / $316.23	Professional		$158.49	$223.87	$316.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $309.03 / $549.54	Professional		$257.04	$309.03	$549.54