Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $186.21 / $257.04	Facility		$120.23	$186.21	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $371.54	Professional		$77.62	$109.65	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $74.13 / $173.78	Professional		$43.65	$74.13	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $275.42	Professional		$109.65	$190.55	$275.42
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $194.98 / $234.42	Facility		$131.83	$194.98	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $245.47	Professional		$141.25	$199.53	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
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 $114.82 / $114.82 / $144.54	Facility		$114.82	$114.82	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $199.53 / $257.04	Professional		$114.82	$199.53	$257.04
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $181.97 / $245.47	Professional		$138.04	$181.97	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $275.42	Professional		$109.65	$165.96	$275.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $104.71 / $147.91	Professional		$77.62	$104.71	$147.91