Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $173.78 / $234.42	Facility		$123.03	$173.78	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $128.82 / $295.12	Professional		$85.11	$128.82	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $186.21	Professional		$144.54	$144.54	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $199.53 / $295.12	Professional		$112.20	$199.53	$295.12
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $190.55 / $251.19	Facility		$102.33	$190.55	$251.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $199.53 / $263.03	Professional		$102.33	$199.53	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $95.50 / $190.55	Professional		$57.54	$95.50	$190.55
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $194.98 / $218.78	Facility		$162.18	$194.98	$218.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $147.91 / $281.84	Facility		$123.03	$147.91	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $295.12	Professional		$109.65	$165.96	$295.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $114.82 / $190.55	Professional		$100.00	$114.82	$190.55