Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $295.12 / $295.12	Facility		$162.18	$295.12	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $162.18	Professional		$77.62	$114.82	$162.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $114.82	Facility		$107.15	$107.15	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $173.78 / $467.74	Professional		$120.23	$173.78	$467.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $177.83 / $436.52	Facility		$125.89	$177.83	$436.52
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $177.83 / $380.19	Professional		$125.89	$177.83	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $75.86	Professional		$44.67	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $229.09 / $323.59 / $331.13	Facility		$229.09	$323.59	$331.13
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $229.09	Facility		$169.82	$169.82	$229.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $288.40 / $416.87	Professional		$169.82	$288.40	$416.87
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $251.19 / $478.63	Facility		$208.93	$251.19	$478.63
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 Professional Modifier Low / Median / High Price $128.82 / $165.96 / $371.54	Professional		$128.82	$165.96	$371.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65