Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $229.09 / $794.33	Facility		$123.03	$229.09	$794.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $112.20 / $239.88	Professional		$81.28	$112.20	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $257.04 / $389.05	Facility		$120.23	$257.04	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $128.82 / $165.96	Professional		$70.79	$128.82	$165.96
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $181.97 / $416.87	Facility		$123.03	$181.97	$416.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $371.54	Professional		$123.03	$173.78	$371.54
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 $123.03 / $123.03 / $181.97	Facility		$123.03	$123.03	$181.97
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $213.80 / $363.08	Facility		$123.03	$213.80	$363.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $147.91	Professional		$109.65	$109.65	$147.91
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $181.97 / $338.84	Facility		$128.82	$181.97	$338.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $109.65 / $147.91	Professional		$104.71	$109.65	$147.91
United Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $147.91 / $147.91	Facility		$123.03	$147.91	$147.91
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $147.91	Professional		$51.29	$63.10	$147.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $123.03 / $218.78	Professional		$54.95	$123.03	$218.78