Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $218.78 / $3,235.94	Facility		$114.82	$218.78	$3,235.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $1,778.28	Professional		$104.71	$104.71	$1,778.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $104.71 / $302.00	Facility		$97.72	$104.71	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $128.82	Professional		$104.71	$104.71	$128.82
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $239.88 / $794.33	Facility		$104.71	$239.88	$794.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $263.03 / $794.33	Professional		$104.71	$263.03	$794.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $114.82 / $141.25	Professional		$75.86	$114.82	$141.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $125.89 / $234.42	Facility		$109.65	$125.89	$234.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $147.91 / $288.40	Facility		$85.11	$147.91	$288.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $128.82 / $128.82	Professional		$125.89	$128.82	$128.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $162.18 / $436.52	Facility		$134.90	$162.18	$436.52
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Professional		$104.71	$104.71	$104.71
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $125.89	Professional		$104.71	$104.71	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $134.90	Professional		$104.71	$104.71	$134.90