Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $77.62 / $109.65	Facility		$41.69	$77.62	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $38.90 / $87.10	Professional		$26.92	$38.90	$87.10
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $37.15 / $37.15 / $51.29	Professional	25	$37.15	$37.15	$51.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $45.71 / $69.18	Professional		$41.69	$45.71	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $64.57 / $104.71	Professional		$34.67	$64.57	$104.71
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $38.90 / $72.44	Facility		$25.12	$38.90	$72.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.02 / $69.18	Professional		$25.12	$38.02	$69.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $32.36 / $38.02	Professional		$21.38	$32.36	$38.02
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $93.33 / $95.50	Facility		$63.10	$93.33	$95.50
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $63.10 / $63.10	Facility		$63.10	$63.10	$63.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $81.28 / $117.49	Professional		$44.67	$81.28	$117.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $64.57 / $100.00	Professional		$47.86	$64.57	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $54.95 / $104.71	Professional		$36.31	$54.95	$104.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $57.54 / $97.72	Professional		$51.29	$57.54	$97.72