Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $288.40 / $1,023.29	Facility		$91.20	$288.40	$1,023.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $169.82 / $562.34	Professional		$81.28	$169.82	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $269.15	Professional		$162.18	$229.09	$269.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $173.78	Facility		$87.10	$87.10	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $269.15 / $380.19	Facility		$131.83	$269.15	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $416.87	Professional		$162.18	$309.03	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $107.15	Professional		$32.36	$33.11	$107.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $97.72 / $323.59	Facility		$97.72	$97.72	$323.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Facility		$97.72	$97.72	$97.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Professional		$97.72	$97.72	$97.72
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Facility		$97.72	$97.72	$97.72
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Professional		$97.72	$97.72	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $102.33	Professional		$85.11	$85.11	$102.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $125.89 / $154.88	Professional		$97.72	$125.89	$154.88