Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $165.96 / $257.04	Facility		$70.79	$165.96	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $58.88 / $97.72	Professional		$46.77	$58.88	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $87.10	Professional		$74.13	$74.13	$87.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $154.88 / $309.03	Facility		$61.66	$154.88	$309.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $138.04 / $229.09	Professional		$61.66	$138.04	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $114.82	Professional		$75.86	$93.33	$114.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $107.15 / $112.20	Facility		$104.71	$107.15	$112.20
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $165.96 / $251.19	Facility		$123.03	$165.96	$251.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $104.71 / $123.03	Professional		$100.00	$104.71	$123.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $120.23	Professional		$93.33	$93.33	$120.23
United Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $162.18 / $162.18	Facility		$64.57	$162.18	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $67.61 / $93.33	Professional		$46.77	$67.61	$93.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $87.10 / $165.96	Professional		$77.62	$87.10	$165.96