Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $97.72 / $234.42	Facility		$97.72	$97.72	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $144.54	Professional		$61.66	$87.10	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $100.00	Professional		$74.13	$74.13	$100.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $218.78 / $416.87	Facility		$91.20	$218.78	$416.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $186.21 / $338.84	Professional		$91.20	$186.21	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $112.20 / $123.03	Professional		$75.86	$112.20	$123.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $141.25 / $147.91	Facility		$114.82	$141.25	$147.91
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $144.54 / $147.91	Professional		$131.83	$144.54	$147.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $213.80 / $309.03	Facility		$125.89	$213.80	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $165.96	Professional		$120.23	$120.23	$165.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $125.89 / $162.18	Professional		$120.23	$125.89	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $234.42 / $234.42	Facility		$72.44	$234.42	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $138.04	Professional		$67.61	$79.43	$138.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $125.89 / $223.87	Professional		$104.71	$125.89	$223.87