Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $794.33 / $2,089.30	Facility		$67.61	$794.33	$2,089.30
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $478.63 / $1,288.25 / $3,801.89	Facility	25	$478.63	$1,288.25	$3,801.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $70.79 / $213.80	Professional		$52.48	$70.79	$213.80
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $66.07 / $147.91 / $309.03	Professional	25	$66.07	$147.91	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $123.03 / $239.88	Professional		$67.61	$123.03	$239.88
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $64.57 / $104.71 / $239.88	Professional	25	$64.57	$104.71	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $123.03 / $229.09	Professional		$72.44	$123.03	$229.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $117.49 / $707.95	Facility		$54.95	$117.49	$707.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $89.13 / $162.18	Professional		$53.70	$89.13	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $58.88	Professional		$32.36	$33.11	$58.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $117.49 / $141.25	Facility		$89.13	$117.49	$141.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $144.54 / $199.53	Professional		$93.33	$144.54	$199.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $125.89 / $181.97	Professional		$97.72	$125.89	$181.97
United Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,380.38	Facility		$1,288.25	$1,288.25	$1,380.38
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $177.83	Professional		$67.61	$95.50	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $72.44 / $131.83	Professional		$69.18	$72.44	$131.83