Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $199.53 / $208.93	Professional		$194.98	$199.53	$208.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $407.38	Facility		$204.17	$204.17	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $218.78 / $588.84	Facility		$66.07	$218.78	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $186.21 / $239.88	Professional		$162.18	$186.21	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $44.67 / $60.26	Professional		$30.20	$44.67	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $165.96 / $165.96	Facility		$138.04	$165.96	$165.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $204.17	Facility		$199.53	$199.53	$204.17
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $158.49 / $223.87	Professional		$104.71	$158.49	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $144.54 / $218.78	Professional		$125.89	$144.54	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04