Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $213.80	Facility		$89.13	$89.13	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $131.83	Professional		$56.23	$79.43	$131.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $107.15	Facility		$107.15	$107.15	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $107.15	Professional		$77.62	$77.62	$107.15
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $199.53 / $380.19	Facility		$83.18	$199.53	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $169.82 / $309.03	Professional		$83.18	$169.82	$309.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $112.20	Professional		$75.86	$102.33	$112.20
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $128.82 / $131.83	Facility		$104.71	$128.82	$131.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $131.83 / $131.83	Professional		$120.23	$131.83	$131.83
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $194.98 / $281.84	Facility		$117.49	$194.98	$281.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $151.36	Professional		$109.65	$109.65	$151.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $114.82 / $147.91	Professional		$109.65	$114.82	$147.91
United Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $218.78 / $218.78	Facility		$66.07	$218.78	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $75.86 / $125.89	Professional		$61.66	$75.86	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $114.82 / $204.17	Professional		$95.50	$114.82	$204.17