Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $457.09	Facility		$190.55	$190.55	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $245.47	Professional		$104.71	$144.54	$245.47
Cigna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Facility		$186.21	$186.21	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $134.90 / $186.21	Professional		$134.90	$134.90	$186.21
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $380.19 / $831.76	Facility		$154.88	$380.19	$831.76
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $346.74 / $588.84	Professional		$154.88	$346.74	$588.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $223.87 / $245.47	Professional		$75.86	$223.87	$245.47
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $275.42 / $295.12	Facility		$234.42	$275.42	$295.12
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $295.12 / $295.12	Professional		$275.42	$295.12	$295.12
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $426.58 / $630.96	Facility		$257.04	$426.58	$630.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $323.59	Professional		$245.47	$245.47	$323.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Facility		$288.40	$288.40	$288.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $257.04 / $331.13	Professional		$239.88	$257.04	$331.13
United Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $398.11 / $398.11	Facility		$162.18	$398.11	$398.11
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $162.18 / $234.42	Professional		$114.82	$162.18	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $446.68	Professional		$208.93	$257.04	$446.68