Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $302.00 / $8,317.64	Facility		$173.78	$302.00	$8,317.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $245.47	Professional		$173.78	$173.78	$245.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $173.78 / $331.13	Facility		$162.18	$173.78	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $213.80	Professional		$173.78	$173.78	$213.80
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $173.78 / $398.11	Facility		$134.90	$173.78	$398.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $173.78 / $338.84	Professional		$120.23	$173.78	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $173.78 / $208.93	Professional		$64.57	$173.78	$208.93
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $190.55 / $323.59	Facility		$173.78	$190.55	$323.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $181.97 / $426.58	Facility		$141.25	$181.97	$426.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $218.78	Professional		$181.97	$181.97	$218.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $194.98 / $489.78	Facility		$117.49	$194.98	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $190.55 / $213.80	Professional		$173.78	$190.55	$213.80
United Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Facility		$173.78	$173.78	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $194.98	Professional		$173.78	$173.78	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $173.78 / $223.87	Professional		$165.96	$173.78	$223.87