Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $707.95	Facility		$295.12	$295.12	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $251.19 / $416.87	Professional		$199.53	$251.19	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Facility		$295.12	$295.12	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $295.12	Professional		$213.80	$213.80	$295.12
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $630.96 / $1,318.26	Facility		$263.03	$630.96	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $549.54 / $977.24	Professional		$263.03	$549.54	$977.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $354.81 / $389.05	Professional		$75.86	$354.81	$389.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $457.09 / $478.63	Facility		$446.68	$457.09	$478.63
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $457.09	Professional		$363.08	$363.08	$457.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $676.08 / $977.24	Facility		$398.11	$676.08	$977.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $501.19	Professional		$380.19	$380.19	$501.19
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $446.68 / $446.68	Facility		$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $398.11 / $512.86	Professional		$380.19	$398.11	$512.86
United Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $691.83 / $691.83	Facility		$275.42	$691.83	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $398.11	Professional		$194.98	$281.84	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $331.13 / $707.95	Professional		$281.84	$331.13	$707.95