Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $288.40 / $380.19	Facility		$213.80	$288.40	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $165.96 / $436.52	Professional		$109.65	$165.96	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $309.03	Professional		$131.83	$165.96	$309.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $208.93 / $398.11	Professional		$123.03	$208.93	$398.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $177.83 / $331.13	Facility		$104.71	$177.83	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $323.59	Professional		$107.15	$173.78	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $50.12 / $50.12	Professional		$32.36	$50.12	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $309.03 / $323.59	Facility		$223.87	$309.03	$323.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $218.78 / $218.78	Facility		$218.78	$218.78	$218.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $251.19 / $407.38	Professional		$177.83	$251.19	$407.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $338.84 / $338.84	Facility		$338.84	$338.84	$338.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $354.81	Professional		$169.82	$234.42	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $338.84	Professional		$128.82	$204.17	$338.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $245.47	Professional		$107.15	$165.96	$245.47