Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $165.96 / $223.87	Facility		$107.15	$165.96	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $83.18 / $204.17	Professional		$54.95	$83.18	$204.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $645.65 / $851.14	Facility		$501.19	$645.65	$851.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $123.03 / $263.03	Professional		$63.10	$123.03	$263.03
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $151.36 / $316.23	Facility		$75.86	$151.36	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $131.83 / $218.78	Professional		$69.18	$131.83	$218.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $50.12	Professional		$32.36	$33.11	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $151.36 / $169.82	Facility		$100.00	$151.36	$169.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Professional		$97.72	$97.72	$97.72
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $120.23	Facility		$117.49	$117.49	$120.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $186.21 / $245.47	Professional		$117.49	$186.21	$245.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $512.86 / $1,000.00	Facility		$346.74	$512.86	$1,000.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $245.47	Professional		$123.03	$173.78	$245.47
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $660.69 / $1,202.26	Facility		$489.78	$660.69	$1,202.26
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $87.10 / $218.78	Professional		$63.10	$87.10	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $97.72 / $162.18	Professional		$85.11	$97.72	$162.18