Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $338.84 / $812.83	Facility		$338.84	$338.84	$812.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $245.47 / $446.68	Professional		$162.18	$245.47	$446.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $245.47 / $245.47	Facility		$245.47	$245.47	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $177.83 / $245.47	Professional		$177.83	$177.83	$245.47
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $588.84 / $1,445.44	Facility		$245.47	$588.84	$1,445.44
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $588.84 / $954.99	Professional		$245.47	$588.84	$954.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $389.05 / $426.58	Professional		$75.86	$389.05	$426.58
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $489.78 / $501.19	Facility		$398.11	$489.78	$501.19
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $501.19 / $501.19	Professional		$457.09	$501.19	$501.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $741.31 / $1,096.48	Facility		$446.68	$741.31	$1,096.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $549.54	Professional		$416.87	$416.87	$549.54
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Facility		$489.78	$489.78	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $436.52 / $562.34	Professional		$416.87	$436.52	$562.34
United Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $645.65 / $645.65	Facility		$194.98	$645.65	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $213.80 / $371.54	Professional		$181.97	$213.80	$371.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $436.52 / $776.25	Professional		$363.08	$436.52	$776.25