Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $257.04 / $891.25	Facility		$138.04	$257.04	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $128.82 / $269.15	Professional		$89.13	$128.82	$269.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $288.40 / $354.81	Facility		$141.25	$288.40	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $144.54 / $194.98	Professional		$66.07	$144.54	$194.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $169.82 / $616.60	Facility		$138.04	$169.82	$616.60
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $380.19	Professional		$138.04	$169.82	$380.19
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 $138.04 / $138.04 / $204.17	Facility		$138.04	$138.04	$204.17
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $239.88 / $407.38	Facility		$138.04	$239.88	$407.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $165.96	Professional		$123.03	$123.03	$165.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $204.17 / $380.19	Facility		$144.54	$204.17	$380.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $123.03 / $154.88	Professional		$117.49	$123.03	$154.88
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $165.96 / $165.96	Facility		$138.04	$165.96	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $154.88	Professional		$57.54	$57.54	$154.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $138.04 / $245.47	Professional		$61.66	$138.04	$245.47