Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Facility		$173.78	$173.78	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $173.78 / $173.78	Professional		$162.18	$173.78	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $147.91 / $177.83	Professional		$141.25	$147.91	$177.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $389.05 / $602.56	Facility		$151.36	$389.05	$602.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $63.10 / $63.10	Professional		$63.10	$63.10	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $75.86 / $100.00	Professional		$50.12	$75.86	$100.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $331.13 / $331.13	Facility		$131.83	$331.13	$331.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $389.05 / $741.31	Facility		$288.40	$389.05	$741.31
United Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $537.03 / $954.99	Facility		$398.11	$537.03	$954.99
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $125.89	Professional		$53.70	$53.70	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $234.42	Professional		$58.88	$58.88	$234.42