Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $218.78 / $309.03	Facility		$141.25	$218.78	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $199.53	Professional		$95.50	$128.82	$199.53
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $128.82 / $128.82 / $147.91	Professional	25	$128.82	$128.82	$147.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Professional		$123.03	$123.03	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $165.96 / $346.74	Professional		$114.82	$165.96	$346.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Facility		$269.15	$269.15	$269.15
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $64.57	Professional		$32.36	$33.11	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $245.47 / $263.03	Facility		$204.17	$245.47	$263.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $173.78	Facility		$169.82	$169.82	$173.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $389.05	Professional		$173.78	$281.84	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $354.81	Professional		$169.82	$263.03	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $346.74	Professional		$138.04	$169.82	$346.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $275.42	Professional		$138.04	$169.82	$275.42