Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $251.19	Facility		$104.71	$104.71	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $138.04	Professional		$54.95	$70.79	$138.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Facility		$74.13	$74.13	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $74.13	Professional		$53.70	$53.70	$74.13
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $181.97 / $446.68	Facility		$74.13	$181.97	$446.68
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $173.78 / $288.40	Professional		$74.13	$173.78	$288.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $120.23 / $131.83	Professional		$75.86	$120.23	$131.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $123.03 / $158.49	Facility		$114.82	$123.03	$158.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $158.49 / $158.49	Professional		$117.49	$158.49	$158.49
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $229.09 / $338.84	Facility		$138.04	$229.09	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $169.82	Professional		$128.82	$128.82	$169.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Facility		$151.36	$151.36	$151.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $134.90 / $177.83	Professional		$128.82	$134.90	$177.83
United Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $190.55 / $190.55	Facility		$57.54	$190.55	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $64.57 / $112.20	Professional		$54.95	$64.57	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $112.20 / $239.88	Professional		$69.18	$112.20	$239.88