Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $154.88 / $363.08	Facility		$154.88	$154.88	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $199.53	Professional		$83.18	$112.20	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $117.49	Professional		$85.11	$85.11	$117.49
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $295.12 / $645.65	Facility		$117.49	$295.12	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $269.15 / $457.09	Professional		$117.49	$269.15	$457.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $173.78 / $194.98	Professional		$75.86	$173.78	$194.98
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $186.21 / $229.09	Facility		$181.97	$186.21	$229.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $229.09 / $229.09	Professional		$186.21	$229.09	$229.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $338.84 / $489.78	Facility		$199.53	$338.84	$489.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $263.03	Professional		$190.55	$190.55	$263.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Facility		$223.87	$223.87	$223.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $199.53 / $257.04	Professional		$190.55	$199.53	$257.04
United Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $302.00 / $302.00	Facility		$91.20	$302.00	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $177.83	Professional		$87.10	$100.00	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $199.53 / $346.74	Professional		$162.18	$199.53	$346.74