Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $120.23 / $288.40	Facility		$120.23	$120.23	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $95.50 / $186.21	Professional		$67.61	$95.50	$186.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $100.00	Professional		$72.44	$72.44	$100.00
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $251.19 / $537.03	Facility		$100.00	$251.19	$537.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $218.78 / $371.54	Professional		$100.00	$218.78	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $144.54 / $158.49	Professional		$75.86	$144.54	$158.49
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $165.96 / $186.21	Facility		$147.91	$165.96	$186.21
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $186.21 / $186.21	Professional		$165.96	$186.21	$186.21
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $275.42 / $398.11	Facility		$162.18	$275.42	$398.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $213.80	Professional		$154.88	$154.88	$213.80
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $181.97 / $181.97	Facility		$181.97	$181.97	$181.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $162.18 / $208.93	Professional		$154.88	$162.18	$208.93
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $263.03 / $263.03	Facility		$104.71	$263.03	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $107.15 / $151.36	Professional		$74.13	$107.15	$151.36
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $162.18 / $288.40	Professional		$134.90	$162.18	$288.40