Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $416.87 / $616.60	Facility		$154.88	$416.87	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $234.42	Professional		$102.33	$144.54	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Professional		$74.13	$74.13	$74.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $338.84 / $562.34	Facility		$257.04	$338.84	$562.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $426.58	Professional		$173.78	$275.42	$426.58
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $302.00 / $549.54	Facility		$131.83	$302.00	$549.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $295.12 / $398.11	Professional		$177.83	$295.12	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $64.57	Professional		$44.67	$50.12	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $239.88 / $257.04	Facility		$204.17	$239.88	$257.04
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $173.78 / $177.83	Facility		$173.78	$173.78	$177.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $354.81	Professional		$173.78	$281.84	$354.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $331.13 / $645.65	Facility		$234.42	$331.13	$645.65
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $354.81	Professional		$181.97	$281.84	$354.81
United Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $389.05 / $691.83	Facility		$288.40	$389.05	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $346.74	Professional		$93.33	$177.83	$346.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $162.18	Professional		$87.10	$117.49	$162.18