Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $147.91 / $354.81	Facility		$147.91	$147.91	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $114.82 / $213.80	Professional		$83.18	$114.82	$213.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $117.49	Professional		$85.11	$85.11	$117.49
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $281.84 / $630.96	Facility		$120.23	$281.84	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $269.15 / $436.52	Professional		$120.23	$269.15	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $169.82 / $186.21	Professional		$75.86	$169.82	$186.21
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $213.80 / $229.09	Facility		$173.78	$213.80	$229.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $218.78 / $229.09	Professional		$199.53	$218.78	$229.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $323.59 / $478.63	Facility		$194.98	$323.59	$478.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $239.88	Professional		$181.97	$181.97	$239.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Facility		$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $190.55 / $245.47	Professional		$181.97	$190.55	$245.47
United Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $295.12 / $295.12	Facility		$89.13	$295.12	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $97.72 / $169.82	Professional		$83.18	$97.72	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $190.55 / $338.84	Professional		$158.49	$190.55	$338.84