Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $363.08 / $1,258.93	Facility		$194.98	$363.08	$1,258.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $177.83 / $380.19	Professional		$125.89	$177.83	$380.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $426.58 / $501.19	Facility		$199.53	$426.58	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $204.17 / $281.84	Professional		$95.50	$204.17	$281.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $239.88 / $870.96	Facility		$194.98	$239.88	$870.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $239.88 / $537.03	Professional		$194.98	$239.88	$537.03
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 $194.98 / $204.17 / $288.40	Facility		$194.98	$204.17	$288.40
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $338.84 / $575.44	Facility		$194.98	$338.84	$575.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $234.42	Professional		$173.78	$173.78	$234.42
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $288.40 / $512.86	Facility		$204.17	$288.40	$512.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $173.78 / $218.78	Professional		$165.96	$173.78	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $234.42 / $234.42	Facility		$194.98	$234.42	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $218.78	Professional		$81.28	$81.28	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $194.98 / $346.74	Professional		$87.10	$194.98	$346.74