Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $158.49 / $190.55	Facility		$91.20	$158.49	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $77.62 / $194.98	Professional		$63.10	$77.62	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $141.25 / $208.93	Professional		$95.50	$141.25	$208.93
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $165.96 / $1,348.96	Facility		$95.50	$165.96	$1,348.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $162.18 / $436.52	Professional		$91.20	$162.18	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $64.57 / $107.15	Professional		$40.74	$64.57	$107.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $138.04 / $144.54	Facility		$117.49	$138.04	$144.54
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $97.72	Facility		$93.33	$93.33	$97.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $208.93	Professional		$97.72	$162.18	$208.93
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $1,258.93 / $2,344.23	Facility		$933.25	$1,258.93	$2,344.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $138.04 / $181.97	Professional		$95.50	$138.04	$181.97
United Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $1,659.59 / $3,548.13	Facility		$645.65	$1,659.59	$3,548.13
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $208.93	Professional		$74.13	$117.49	$208.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $83.18 / $117.49	Professional		$61.66	$83.18	$117.49