Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $204.17 / $239.88	Facility		$100.00	$204.17	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $79.43 / $131.83	Professional		$61.66	$79.43	$131.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $138.04	Professional		$114.82	$114.82	$138.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Facility		$83.18	$83.18	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $83.18	Professional		$61.66	$61.66	$83.18
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $245.47 / $457.09	Facility		$138.04	$245.47	$457.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $208.93 / $338.84	Professional		$125.89	$208.93	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $114.82 / $125.89	Professional		$75.86	$114.82	$125.89
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $151.36	Facility		$144.54	$144.54	$151.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Professional		$120.23	$120.23	$120.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $218.78 / $323.59	Facility		$131.83	$218.78	$323.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $162.18	Professional		$123.03	$123.03	$162.18
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Facility		$144.54	$144.54	$144.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $128.82 / $169.82	Professional		$123.03	$128.82	$169.82
United Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $213.80 / $213.80	Facility		$66.07	$213.80	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $72.44 / $125.89	Professional		$61.66	$72.44	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $229.09	Professional		$107.15	$128.82	$229.09