Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Facility		$165.96	$165.96	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $194.98 / $275.42	Professional		$151.36	$194.98	$275.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $354.81	Professional		$354.81	$354.81	$354.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $316.23 / $316.23	Facility		$316.23	$316.23	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Professional		$181.97	$181.97	$181.97
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $288.40 / $478.63	Facility		$186.21	$288.40	$478.63
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $478.63	Professional		$181.97	$281.84	$478.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $398.11 / $407.38	Facility		$316.23	$398.11	$407.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $416.87 / $602.56	Professional		$281.84	$416.87	$602.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $389.05 / $512.86	Professional		$281.84	$389.05	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $512.86	Professional		$204.17	$295.12	$512.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $199.53 / $354.81	Professional		$186.21	$199.53	$354.81