Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $112.20	Facility		$46.77	$46.77	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $38.02 / $141.25	Professional		$30.90	$38.02	$141.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $70.79	Professional		$67.61	$67.61	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $47.86	Facility		$46.77	$46.77	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $46.77	Professional		$33.88	$33.88	$46.77
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $97.72 / $208.93	Facility		$40.74	$97.72	$208.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $85.11 / $151.36	Professional		$40.74	$85.11	$151.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $56.23 / $64.57	Professional		$50.12	$56.23	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $72.44 / $74.13	Facility		$58.88	$72.44	$74.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $74.13 / $74.13	Professional		$66.07	$74.13	$74.13
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $107.15 / $158.49	Facility		$64.57	$107.15	$158.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $74.13	Professional		$60.26	$60.26	$74.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Facility		$72.44	$72.44	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $63.10 / $83.18	Professional		$60.26	$63.10	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $104.71 / $104.71	Facility		$42.66	$104.71	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $61.66	Professional		$30.20	$42.66	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $112.20	Professional		$52.48	$63.10	$112.20