Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $181.97 / $218.78	Facility		$104.71	$181.97	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $107.15 / $144.54	Professional		$104.71	$107.15	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $104.71 / $194.98	Facility		$100.00	$104.71	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $125.89	Professional		$104.71	$104.71	$125.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $104.71 / $234.42	Facility		$85.11	$104.71	$234.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $104.71 / $204.17	Professional		$81.28	$104.71	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $104.71 / $125.89	Professional		$70.79	$104.71	$125.89
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $109.65 / $190.55	Facility		$100.00	$109.65	$190.55
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $109.65 / $257.04	Facility		$87.10	$109.65	$257.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $107.15 / $125.89	Professional		$107.15	$107.15	$125.89
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $117.49 / $295.12	Facility		$87.10	$117.49	$295.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $114.82 / $128.82	Professional		$104.71	$114.82	$128.82
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $117.49	Professional		$104.71	$104.71	$117.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $104.71 / $138.04	Professional		$97.72	$104.71	$138.04