Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $457.09 / $1,096.48	Facility		$457.09	$457.09	$1,096.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $398.11 / $741.31	Professional		$281.84	$398.11	$741.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $524.81	Professional		$524.81	$524.81	$524.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Facility		$407.38	$407.38	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $302.00 / $407.38	Professional		$302.00	$302.00	$407.38
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $977.24 / $1,995.26	Facility		$416.87	$977.24	$1,995.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $851.14 / $1,513.56	Professional		$416.87	$851.14	$1,513.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $537.03 / $588.84	Professional		$75.86	$537.03	$588.84
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $691.83 / $851.14	Facility		$562.34	$691.83	$851.14
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $707.95 / $851.14	Professional		$676.08	$707.95	$851.14
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $616.60 / $1,023.29 / $1,513.56	Facility		$616.60	$1,023.29	$1,513.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $588.84 / $776.25	Professional		$588.84	$588.84	$776.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $691.83 / $691.83	Facility		$691.83	$691.83	$691.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $616.60 / $794.33	Professional		$602.56	$616.60	$794.33
United Facility/Professional Facility Modifier Low / Median / High Price $331.13 / $1,071.52 / $1,071.52	Facility		$331.13	$1,071.52	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $436.52 / $630.96	Professional		$309.03	$436.52	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $616.60 / $1,071.52	Professional		$501.19	$616.60	$1,071.52