Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $169.82 / $245.47	Facility		$128.82	$169.82	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $123.03 / $346.74	Professional		$67.61	$123.03	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $112.20 / $208.93	Professional		$87.10	$112.20	$208.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $128.82 / $245.47	Professional		$74.13	$128.82	$245.47
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $107.15 / $208.93	Facility		$63.10	$107.15	$208.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $104.71 / $199.53	Professional		$63.10	$104.71	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $102.33 / $204.17	Professional		$52.48	$102.33	$204.17
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $199.53 / $208.93	Facility		$144.54	$199.53	$208.93
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Facility		$138.04	$138.04	$138.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $158.49 / $257.04	Professional		$107.15	$158.49	$257.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $218.78 / $218.78	Facility		$218.78	$218.78	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $141.25 / $223.87	Professional		$100.00	$141.25	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $208.93	Professional		$75.86	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $107.15 / $158.49	Professional		$64.57	$107.15	$158.49