Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $338.84 / $407.38	Facility		$199.53	$338.84	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $199.53 / $275.42	Professional		$194.98	$199.53	$275.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $194.98 / $194.98	Facility		$186.21	$194.98	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $223.87	Professional		$194.98	$194.98	$223.87
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $204.17 / $446.68	Facility		$154.88	$204.17	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $199.53 / $398.11	Professional		$154.88	$199.53	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $194.98 / $234.42	Professional		$60.26	$194.98	$234.42
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $190.55 / $281.84	Facility		$173.78	$190.55	$281.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $213.80 / $575.44	Facility		$162.18	$213.80	$575.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $229.09	Professional		$199.53	$199.53	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $218.78 / $537.03	Facility		$169.82	$218.78	$537.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $213.80 / $239.88	Professional		$194.98	$213.80	$239.88
United Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Facility		$194.98	$194.98	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $218.78	Professional		$194.98	$194.98	$218.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $194.98 / $257.04	Professional		$181.97	$194.98	$257.04