Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $204.17 / $416.87	Facility		$144.54	$204.17	$416.87
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $97.72 / $288.40 / $776.25	Facility	25	$97.72	$288.40	$776.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $177.83 / $478.63	Professional		$89.13	$177.83	$478.63
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $100.00 / $213.80 / $524.81	Professional	25	$100.00	$213.80	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $213.80 / $354.81	Professional		$138.04	$213.80	$354.81
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $151.36 / $199.53 / $363.08	Professional	25	$151.36	$199.53	$363.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $125.89 / $223.87	Facility		$85.11	$125.89	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $199.53 / $398.11	Professional		$117.49	$199.53	$398.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $154.88 / $346.74	Facility		$95.50	$154.88	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $154.88 / $323.59	Professional		$95.50	$154.88	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $89.13 / $194.98	Professional		$32.36	$89.13	$194.98
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $295.12 / $363.08	Facility		$199.53	$295.12	$363.08
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Facility		$239.88	$239.88	$239.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $275.42 / $446.68	Professional		$186.21	$275.42	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $251.19 / $380.19	Professional		$186.21	$251.19	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $186.21 / $309.03	Professional		$114.82	$186.21	$309.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $186.21 / $275.42	Professional		$125.89	$186.21	$275.42