Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $275.42 / $549.54	Facility		$158.49	$275.42	$549.54
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $660.69 / $660.69 / $1,148.15	Facility	25	$660.69	$660.69	$1,148.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $660.69	Professional		$144.54	$245.47	$660.69
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $169.82 / $316.23 / $758.58	Professional	25	$169.82	$316.23	$758.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $436.52	Professional		$169.82	$263.03	$436.52
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $186.21 / $239.88 / $436.52	Professional	25	$186.21	$239.88	$436.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $147.91 / $288.40	Facility		$85.11	$147.91	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $524.81	Professional		$173.78	$269.15	$524.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $229.09 / $446.68	Facility		$134.90	$229.09	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $426.58	Professional		$141.25	$223.87	$426.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $109.65 / $239.88	Professional		$32.36	$109.65	$239.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $389.05 / $446.68	Facility		$281.84	$389.05	$446.68
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Facility		$295.12	$295.12	$295.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $346.74 / $549.54	Professional		$234.42	$346.74	$549.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $323.59 / $489.78	Professional		$239.88	$323.59	$489.78
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $426.58	Professional		$169.82	$263.03	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $338.84	Professional		$162.18	$229.09	$338.84