Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $602.56 / $1,348.96	Facility		$125.89	$602.56	$1,348.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $158.49	Professional		$87.10	$109.65	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $295.12 / $346.74	Facility		$138.04	$295.12	$346.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $134.90 / $616.60	Facility		$120.23	$134.90	$616.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $229.09	Professional		$107.15	$134.90	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $147.91 / $234.42	Facility		$120.23	$147.91	$234.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $234.42 / $398.11	Facility		$134.90	$234.42	$398.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $162.18	Professional		$120.23	$120.23	$162.18
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $199.53 / $371.54	Facility		$141.25	$199.53	$371.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $120.23 / $151.36	Professional		$114.82	$120.23	$151.36
United Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $162.18 / $162.18	Facility		$134.90	$162.18	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $151.36	Professional		$56.23	$56.23	$151.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $134.90 / $239.88	Professional		$60.26	$134.90	$239.88