Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $295.12	Facility		$123.03	$123.03	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $107.15 / $194.98	Professional		$87.10	$107.15	$194.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Facility		$144.54	$144.54	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $144.54	Professional		$104.71	$104.71	$144.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $257.04 / $524.81	Facility		$109.65	$257.04	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $223.87 / $398.11	Professional		$109.65	$223.87	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $141.25 / $154.88	Professional		$75.86	$141.25	$154.88
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $173.78 / $186.21	Facility		$147.91	$173.78	$186.21
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $186.21 / $190.55	Professional		$165.96	$186.21	$190.55
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $269.15 / $398.11	Facility		$162.18	$269.15	$398.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $213.80	Professional		$154.88	$154.88	$213.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Facility		$181.97	$181.97	$181.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $162.18 / $208.93	Professional		$151.36	$162.18	$208.93
United Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $281.84 / $281.84	Facility		$85.11	$281.84	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $93.33 / $165.96	Professional		$81.28	$93.33	$165.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $162.18 / $281.84	Professional		$131.83	$162.18	$281.84