Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $208.93 / $489.78	Facility		$208.93	$208.93	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $269.15	Professional		$125.89	$162.18	$269.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $169.82	Facility		$169.82	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $169.82	Professional		$125.89	$125.89	$169.82
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $426.58 / $912.01	Facility		$169.82	$426.58	$912.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $371.54 / $630.96	Professional		$169.82	$371.54	$630.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $245.47 / $269.15	Professional		$75.86	$245.47	$269.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $309.03 / $316.23	Facility		$269.15	$309.03	$316.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Professional		$251.19	$251.19	$251.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $467.74 / $691.83	Facility		$281.84	$467.74	$691.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $346.74	Professional		$263.03	$263.03	$346.74
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Facility		$309.03	$309.03	$309.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $275.42 / $354.81	Professional		$263.03	$275.42	$354.81
United Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $446.68 / $446.68	Facility		$181.97	$446.68	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $181.97 / $257.04	Professional		$128.82	$181.97	$257.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $229.09 / $489.78	Professional		$165.96	$229.09	$489.78