Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $302.00 / $776.25	Facility		$141.25	$302.00	$776.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $123.03 / $389.05	Professional		$75.86	$123.03	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $190.55 / $398.11	Professional		$120.23	$190.55	$398.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $331.13 / $416.87	Facility		$147.91	$331.13	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $151.36 / $194.98	Professional		$81.28	$151.36	$194.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $181.97 / $389.05	Facility		$141.25	$181.97	$389.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $194.98 / $416.87	Professional		$141.25	$194.98	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $151.36	Professional		$75.86	$125.89	$151.36
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $269.15	Facility		$141.25	$141.25	$269.15
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $251.19 / $426.58	Facility		$141.25	$251.19	$426.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $169.82	Professional		$128.82	$128.82	$169.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $213.80 / $389.05	Facility		$151.36	$213.80	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $128.82 / $158.49	Professional		$120.23	$128.82	$158.49
United Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $169.82 / $169.82	Facility		$141.25	$169.82	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $74.13 / $169.82	Professional		$60.26	$74.13	$169.82