Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $91.20 / $213.80	Facility		$91.20	$91.20	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $67.61 / $117.49	Professional		$50.12	$67.61	$117.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Facility		$85.11	$85.11	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $85.11	Professional		$61.66	$61.66	$85.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $169.82 / $380.19	Facility		$72.44	$169.82	$380.19
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $158.49 / $269.15	Professional		$72.44	$158.49	$269.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $114.82	Professional		$75.86	$102.33	$114.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $114.82 / $134.90	Facility		$107.15	$114.82	$134.90
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $134.90 / $134.90	Professional		$114.82	$134.90	$134.90
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $199.53 / $288.40	Facility		$117.49	$199.53	$288.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $147.91	Professional		$112.20	$112.20	$147.91
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Facility		$131.83	$131.83	$131.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $117.49 / $151.36	Professional		$112.20	$117.49	$151.36
United Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $186.21 / $186.21	Facility		$56.23	$186.21	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $61.66 / $109.65	Professional		$52.48	$61.66	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $204.17	Professional		$69.18	$95.50	$204.17