Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $389.05 / $1,348.96	Facility		$208.93	$389.05	$1,348.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $407.38	Professional		$134.90	$190.55	$407.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $457.09 / $537.03	Facility		$213.80	$457.09	$537.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $218.78 / $302.00	Professional		$102.33	$218.78	$302.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $257.04 / $933.25	Facility		$208.93	$257.04	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $575.44	Professional		$208.93	$257.04	$575.44
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 $208.93 / $218.78 / $309.03	Facility		$208.93	$218.78	$309.03
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $363.08 / $616.60	Facility		$208.93	$363.08	$616.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $251.19	Professional		$186.21	$186.21	$251.19
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $309.03 / $575.44	Facility		$218.78	$309.03	$575.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $186.21 / $234.42	Professional		$177.83	$186.21	$234.42
United Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $251.19 / $251.19	Facility		$208.93	$251.19	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $234.42	Professional		$87.10	$87.10	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $208.93 / $371.54	Professional		$93.33	$208.93	$371.54