Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $64.57 / $120.23	Facility		$38.90	$64.57	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $64.57 / $151.36	Professional		$23.99	$64.57	$151.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $123.03	Professional		$75.86	$109.65	$123.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $44.67 / $44.67	Facility		$44.67	$44.67	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $38.02 / $54.95	Professional		$38.02	$38.02	$54.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $83.18 / $154.88	Facility		$44.67	$83.18	$154.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $95.50 / $158.49	Professional		$44.67	$95.50	$158.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $69.18 / $75.86	Professional		$63.10	$69.18	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $69.18 / $72.44	Facility		$63.10	$69.18	$72.44
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Professional		$60.26	$60.26	$60.26
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $77.62 / $112.20	Facility		$45.71	$77.62	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $60.26 / $77.62	Professional		$57.54	$60.26	$77.62
United Facility/Professional Facility Modifier Low / Median / High Price $0.51 / $31.62 / $50.12	Facility		$0.51	$31.62	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $33.88 / $60.26	Professional		$29.51	$33.88	$60.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $60.26 / $107.15	Professional		$50.12	$60.26	$107.15