Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $177.83 / $257.04	Facility		$95.50	$177.83	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $245.47	Professional		$67.61	$95.50	$245.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $1,445.44 / $2,754.23	Facility		$691.83	$1,445.44	$2,754.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $251.19	Professional		$114.82	$173.78	$251.19
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $204.17 / $2,344.23	Facility		$131.83	$204.17	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $234.42	Professional		$131.83	$190.55	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $154.88 / $204.17	Facility		$125.89	$154.88	$204.17
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $181.97 / $275.42	Professional		$104.71	$181.97	$275.42
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $1,513.56 / $2,951.21	Facility		$1,000.00	$1,513.56	$2,951.21
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $223.87	Professional		$107.15	$165.96	$223.87
United Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,041.74 / $3,715.35	Facility		$1,513.56	$2,041.74	$3,715.35
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $89.13 / $218.78	Professional		$69.18	$89.13	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $138.04 / $194.98	Professional		$117.49	$138.04	$194.98