Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $323.59	Facility		$138.04	$138.04	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $177.83	Professional		$77.62	$109.65	$177.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $112.20	Professional		$81.28	$81.28	$112.20
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $281.84 / $575.44	Facility		$112.20	$281.84	$575.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $239.88 / $416.87	Professional		$112.20	$239.88	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $154.88 / $169.82	Professional		$75.86	$154.88	$169.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $177.83 / $204.17	Facility		$162.18	$177.83	$204.17
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $204.17 / $204.17	Professional		$177.83	$204.17	$204.17
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $295.12 / $436.52	Facility		$177.83	$295.12	$436.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $234.42	Professional		$169.82	$169.82	$234.42
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Facility		$199.53	$199.53	$199.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $177.83 / $229.09	Professional		$165.96	$177.83	$229.09
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 / $102.33 / $169.82	Professional		$83.18	$102.33	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $177.83 / $309.03	Professional		$144.54	$177.83	$309.03