Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $169.82 / $245.47	Facility		$128.82	$169.82	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $218.78	Professional		$95.50	$128.82	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $112.20 / $251.19	Professional		$93.33	$112.20	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $134.90 / $245.47	Professional		$104.71	$134.90	$245.47
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $123.03 / $199.53	Facility		$95.50	$123.03	$199.53
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $123.03 / $194.98	Professional		$95.50	$123.03	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $60.26 / $83.18	Professional		$32.36	$60.26	$83.18
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $257.04 / $257.04	Facility		$169.82	$257.04	$257.04
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Facility		$173.78	$173.78	$173.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $323.59	Professional		$144.54	$213.80	$323.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,819.70	Facility		$1,202.26	$1,202.26	$1,819.70
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $154.88 / $208.93	Professional		$125.89	$154.88	$208.93
United Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $1,380.38 / $1,905.46	Facility		$1,258.93	$1,380.38	$1,905.46
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $316.23	Professional		$123.03	$173.78	$316.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $190.55	Professional		$100.00	$134.90	$190.55