Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $134.90 / $245.47	Facility		$91.20	$134.90	$245.47
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $93.33 / $239.88 / $407.38	Facility	25	$93.33	$239.88	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $120.23 / $309.03	Professional		$66.07	$120.23	$309.03
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $134.90 / $316.23	Professional	25	$70.79	$134.90	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $223.87	Professional		$89.13	$131.83	$223.87
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $93.33 / $125.89 / $223.87	Professional	25	$93.33	$125.89	$223.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $125.89 / $147.91	Facility		$85.11	$125.89	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $128.82 / $245.47	Professional		$74.13	$128.82	$245.47
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $109.65 / $218.78	Facility		$69.18	$109.65	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $107.15 / $213.80	Professional		$67.61	$107.15	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $56.23 / $128.82	Professional		$32.36	$56.23	$128.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $204.17 / $223.87	Facility		$147.91	$204.17	$223.87
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $147.91 / $147.91	Facility		$147.91	$147.91	$147.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $169.82 / $281.84	Professional		$104.71	$169.82	$281.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $239.88	Professional		$112.20	$154.88	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $128.82 / $213.80	Professional		$77.62	$128.82	$213.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $117.49 / $169.82	Professional		$70.79	$117.49	$169.82