Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $295.12 / $977.24	Facility		$138.04	$295.12	$977.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $138.04 / $616.60	Professional		$95.50	$138.04	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $380.19	Professional		$208.93	$208.93	$380.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $309.03 / $371.54	Facility		$194.98	$309.03	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $426.58	Professional		$128.82	$223.87	$426.58
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $263.03 / $389.05	Facility		$123.03	$263.03	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $269.15 / $380.19	Professional		$147.91	$269.15	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $66.07	Professional		$32.36	$33.11	$66.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $263.03 / $281.84	Facility		$204.17	$263.03	$281.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Facility		$186.21	$186.21	$186.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $302.00 / $389.05	Professional		$186.21	$302.00	$389.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $251.19 / $489.78	Facility		$165.96	$251.19	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $380.19	Professional		$190.55	$275.42	$380.19
United Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $331.13 / $588.84	Facility		$245.47	$331.13	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $151.36 / $354.81	Professional		$134.90	$151.36	$354.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $147.91 / $245.47	Professional		$128.82	$147.91	$245.47