Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $151.36 / $190.55	Facility		$102.33	$151.36	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $75.86 / $128.82	Professional		$61.66	$75.86	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $141.25 / $208.93	Professional		$95.50	$141.25	$208.93
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $95.50 / $177.83	Facility		$69.18	$95.50	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $93.33 / $169.82	Professional		$69.18	$93.33	$169.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $66.07	Professional		$32.36	$33.11	$66.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $162.18 / $169.82	Facility		$112.20	$162.18	$169.82
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $112.20 / $112.20	Facility		$109.65	$112.20	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $158.49 / $218.78	Professional		$97.72	$158.49	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $194.98	Professional		$97.72	$131.83	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $229.09	Professional		$89.13	$131.83	$229.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $91.20 / $128.82	Professional		$66.07	$91.20	$128.82