Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $123.03 / $239.88	Facility		$100.00	$123.03	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $97.72 / $173.78	Professional		$72.44	$97.72	$173.78
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $20.42 / $102.33 / $162.18	Professional	25	$20.42	$102.33	$162.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $100.00 / $154.88	Professional		$85.11	$100.00	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $114.82 / $229.09	Professional		$81.28	$114.82	$229.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $218.78 / $218.78	Facility		$218.78	$218.78	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $218.78 / $218.78	Professional		$218.78	$218.78	$218.78
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 $144.54 / $177.83 / $213.80	Facility		$144.54	$177.83	$213.80
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $138.04	Facility		$117.49	$117.49	$138.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $229.09 / $316.23	Professional		$138.04	$229.09	$316.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $208.93 / $281.84	Professional		$120.23	$208.93	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $123.03 / $275.42	Professional		$100.00	$123.03	$275.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $141.25 / $223.87	Professional		$114.82	$141.25	$223.87