Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $213.80 / $295.12	Facility		$114.82	$213.80	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $112.20 / $173.78	Professional		$81.28	$112.20	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Professional		$100.00	$100.00	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $269.15	Professional		$93.33	$134.90	$269.15
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Facility		$263.03	$263.03	$263.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Professional		$263.03	$263.03	$263.03
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 $138.04 / $213.80 / $263.03	Facility		$138.04	$213.80	$263.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $134.90 / $169.82	Facility		$134.90	$134.90	$169.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $380.19	Professional		$169.82	$275.42	$380.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $257.04 / $346.74	Professional		$138.04	$257.04	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $338.84	Professional		$104.71	$138.04	$338.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $165.96 / $269.15	Professional		$138.04	$165.96	$269.15