Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $114.82 / $218.78	Professional		$107.15	$114.82	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $125.89	Facility		$123.03	$123.03	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $125.89	Professional		$104.71	$104.71	$125.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $204.17 / $245.47	Professional		$75.86	$204.17	$245.47
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $323.59 / $389.05	Facility		$288.40	$323.59	$389.05
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $389.05 / $389.05	Professional		$323.59	$389.05	$389.05
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $17.38 / $19.95 / $199.53	Facility		$17.38	$19.95	$199.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $24.55 / $199.53	Professional		$17.38	$24.55	$199.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $23.99 / $23.99	Professional		$19.95	$23.99	$23.99
United Facility/Professional Facility Modifier Low / Median / High Price $1.29 / $66.07 / $154.88	Facility		$1.29	$66.07	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $131.83 / $169.82	Professional		$97.72	$131.83	$169.82