Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $239.88 / $630.96	Facility		$128.82	$239.88	$630.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $97.72 / $245.47	Professional		$60.26	$97.72	$245.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $107.15 / $125.89	Facility		$60.26	$107.15	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $162.18 / $338.84	Professional		$102.33	$162.18	$338.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $123.03 / $288.40	Facility		$83.18	$123.03	$288.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $120.23 / $251.19	Professional		$83.18	$120.23	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $72.44	Professional		$32.36	$33.11	$72.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $186.21 / $223.87	Facility		$147.91	$186.21	$223.87
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $213.80 / $309.03	Facility		$147.91	$213.80	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $218.78 / $323.59	Professional		$151.36	$218.78	$323.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $165.96 / $316.23	Facility		$138.04	$165.96	$316.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $114.82 / $204.17	Professional		$112.20	$114.82	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $138.04 / $257.04	Professional		$89.13	$138.04	$257.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $125.89 / $218.78	Professional		$114.82	$125.89	$218.78