Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $85.11 / $208.93	Professional		$41.69	$85.11	$208.93
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $64.57 / $104.71 / $323.59	Professional	25	$64.57	$104.71	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $154.88	Professional		$87.10	$117.49	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $97.72 / $204.17	Professional		$50.12	$97.72	$204.17
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $109.65 / $234.42	Facility		$66.07	$109.65	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $109.65 / $213.80	Professional		$66.07	$109.65	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $33.11 / $57.54	Professional		$31.62	$33.11	$57.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $162.18 / $177.83	Facility		$112.20	$162.18	$177.83
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $134.90 / $229.09	Professional		$85.11	$134.90	$229.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $67.61 / $117.49	Professional		$50.12	$67.61	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $95.50 / $169.82	Professional		$52.48	$95.50	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $69.18 / $128.82	Professional		$44.67	$69.18	$128.82