Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $123.03 / $173.78	Facility		$75.86	$123.03	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $69.18 / $100.00	Professional		$52.48	$69.18	$100.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $14.45 / $70.79 / $75.86	Professional	25	$14.45	$70.79	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $61.66 / $100.00	Professional		$58.88	$61.66	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $177.83	Professional		$61.66	$87.10	$177.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Facility		$151.36	$151.36	$151.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Professional		$151.36	$151.36	$151.36
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 $107.15 / $131.83 / $147.91	Facility		$107.15	$131.83	$147.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $95.50	Facility		$89.13	$89.13	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $158.49 / $213.80	Professional		$95.50	$158.49	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $144.54 / $194.98	Professional		$91.20	$144.54	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $194.98	Professional		$75.86	$93.33	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $97.72 / $151.36	Professional		$79.43	$97.72	$151.36