Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $97.72 / $194.98	Facility		$54.95	$97.72	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $74.13 / $147.91	Professional		$39.81	$74.13	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Professional		$141.25	$141.25	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $93.33 / $181.97	Professional		$47.86	$93.33	$181.97
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $70.79 / $117.49	Facility		$38.90	$70.79	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $64.57 / $112.20	Professional		$38.90	$64.57	$112.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.11 / $56.23	Professional		$26.92	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $158.49 / $162.18	Facility		$97.72	$158.49	$162.18
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $107.15	Facility		$107.15	$107.15	$107.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $109.65 / $199.53	Professional		$57.54	$109.65	$199.53
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Facility		$162.18	$162.18	$162.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $104.71 / $169.82	Professional		$57.54	$104.71	$169.82
United Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $37.15 / $40.74	Facility		$30.20	$37.15	$40.74
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $100.00 / $190.55	Professional		$52.48	$100.00	$190.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $72.44 / $120.23	Professional		$38.02	$72.44	$120.23