Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $154.88 / $199.53	Facility		$125.89	$154.88	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $85.11 / $199.53	Professional		$61.66	$85.11	$199.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $79.43	Professional		$66.07	$66.07	$79.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $213.80	Professional		$74.13	$117.49	$213.80
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $102.33 / $177.83	Facility		$66.07	$102.33	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $173.78	Professional		$64.57	$100.00	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $50.12 / $64.57	Professional		$33.11	$50.12	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $162.18 / $173.78	Facility		$120.23	$162.18	$173.78
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $223.87	Professional		$104.71	$138.04	$223.87
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Facility		$181.97	$181.97	$181.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $190.55	Professional		$97.72	$128.82	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $114.82 / $181.97	Professional		$74.13	$114.82	$181.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $89.13 / $125.89	Professional		$63.10	$89.13	$125.89