Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $416.87 / $1,862.09	Facility		$263.03	$416.87	$1,862.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $218.78 / $501.19	Professional		$173.78	$218.78	$501.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $575.44 / $676.08	Facility		$199.53	$575.44	$676.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $302.00 / $371.54	Professional		$138.04	$302.00	$371.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $323.59 / $891.25	Facility		$263.03	$323.59	$891.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $323.59 / $724.44	Professional		$263.03	$323.59	$724.44
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 $263.03 / $263.03 / $457.09	Facility		$263.03	$263.03	$457.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $457.09 / $776.25	Facility		$263.03	$457.09	$776.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $309.03	Professional		$234.42	$234.42	$309.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $389.05 / $724.44	Facility		$275.42	$389.05	$724.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $234.42 / $288.40	Professional		$223.87	$234.42	$288.40
United Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $309.03 / $309.03	Facility		$263.03	$309.03	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $295.12	Professional		$109.65	$109.65	$295.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $467.74	Professional		$117.49	$117.49	$467.74