Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2.69 / $75.86 / $181.97	Facility		$2.69	$75.86	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $70.79 / $181.97	Professional		$36.31	$70.79	$181.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $112.20	Professional		$95.50	$95.50	$112.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $70.79 / $74.13	Facility		$70.79	$70.79	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $51.29 / $74.13	Professional		$51.29	$51.29	$74.13
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $169.82 / $323.59	Facility		$70.79	$169.82	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $144.54 / $263.03	Professional		$70.79	$144.54	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $87.10 / $95.50	Professional		$75.86	$87.10	$95.50
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $112.20 / $147.91	Facility		$109.65	$112.20	$147.91
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $89.13 / $112.20	Professional		$81.28	$89.13	$112.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $165.96 / $245.47	Facility		$100.00	$165.96	$245.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $123.03	Professional		$93.33	$93.33	$123.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $125.89	Professional		$97.72	$97.72	$125.89
United Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $186.21 / $186.21	Facility		$56.23	$186.21	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $61.66 / $107.15	Professional		$52.48	$61.66	$107.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $81.28 / $173.78	Professional		$72.44	$81.28	$173.78