Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $331.13 / $1,202.26	Facility		$144.54	$331.13	$1,202.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $426.58	Professional		$102.33	$128.82	$426.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $309.03 / $426.58	Facility		$151.36	$309.03	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $162.18 / $204.17	Professional		$83.18	$162.18	$204.17
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $229.09 / $398.11	Facility		$144.54	$229.09	$398.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $245.47 / $436.52	Professional		$144.54	$245.47	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $154.88	Professional		$75.86	$125.89	$154.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $275.42	Facility		$144.54	$144.54	$275.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $251.19 / $436.52	Facility		$144.54	$251.19	$436.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $173.78	Professional		$128.82	$128.82	$173.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $218.78 / $398.11	Facility		$151.36	$218.78	$398.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $128.82 / $162.18	Professional		$123.03	$128.82	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $173.78 / $173.78	Facility		$144.54	$173.78	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $229.09	Professional		$87.10	$104.71	$229.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $144.54 / $263.03	Professional		$64.57	$144.54	$263.03