Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $316.23 / $1,096.48	Facility		$169.82	$316.23	$1,096.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $154.88 / $331.13	Professional		$57.54	$154.88	$331.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $346.74 / $436.52	Facility		$66.07	$346.74	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $194.98 / $239.88	Professional		$89.13	$194.98	$239.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $208.93 / $524.81	Facility		$169.82	$208.93	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $208.93 / $467.74	Professional		$169.82	$208.93	$467.74
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 $169.82 / $169.82 / $316.23	Facility		$169.82	$169.82	$316.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $295.12 / $501.19	Facility		$169.82	$295.12	$501.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $204.17	Professional		$151.36	$151.36	$204.17
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $251.19 / $467.74	Facility		$177.83	$251.19	$467.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $151.36 / $204.17	Professional		$144.54	$151.36	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $204.17 / $204.17	Facility		$169.82	$204.17	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $190.55	Professional		$70.79	$70.79	$190.55
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $169.82 / $302.00	Professional		$75.86	$169.82	$302.00