Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $144.54 / $363.08	Facility		$61.66	$144.54	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $67.61 / $177.83	Professional		$42.66	$67.61	$177.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $38.90	Professional		$38.90	$38.90	$38.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $144.54 / $208.93	Facility		$67.61	$144.54	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $75.86 / $100.00	Professional		$40.74	$75.86	$100.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $95.50 / $229.09	Facility		$66.07	$95.50	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $199.53	Professional		$66.07	$93.33	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $75.86	Professional		$52.48	$63.10	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $66.07 / $123.03	Facility		$66.07	$66.07	$123.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $114.82 / $194.98	Facility		$66.07	$114.82	$194.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $77.62	Professional		$58.88	$58.88	$77.62
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $97.72 / $177.83	Facility		$69.18	$97.72	$177.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $58.88 / $75.86	Professional		$54.95	$58.88	$75.86
United Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $77.62 / $77.62	Facility		$66.07	$77.62	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $37.15 / $77.62	Professional		$27.54	$37.15	$77.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $66.07 / $117.49	Professional		$29.51	$66.07	$117.49