Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $371.54 / $954.99	Facility		$114.82	$371.54	$954.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $114.82 / $331.13	Professional		$63.10	$114.82	$331.13
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $275.42 / $645.65	Professional	50	$173.78	$275.42	$645.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $154.88 / $229.09	Professional		$123.03	$154.88	$229.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Facility		$165.96	$165.96	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $125.89 / $257.04	Professional		$69.18	$125.89	$257.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $120.23 / $223.87	Facility		$74.13	$120.23	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $120.23 / $204.17	Professional		$74.13	$120.23	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $60.26	Professional		$32.36	$33.11	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $165.96 / $181.97	Facility		$120.23	$165.96	$181.97
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $123.03	Facility		$114.82	$114.82	$123.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $229.09	Professional		$89.13	$154.88	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $758.58 / $1,445.44	Facility		$549.54	$758.58	$1,445.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $131.83 / $204.17	Professional		$83.18	$131.83	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $1,047.13 / $2,238.72	Facility		$416.87	$1,047.13	$2,238.72
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $112.20 / $213.80	Professional		$74.13	$112.20	$213.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $100.00 / $141.25	Professional		$58.88	$100.00	$141.25