Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Facility		$223.87	$223.87	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $416.87	Professional		$204.17	$204.17	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $524.81	Facility		$194.98	$194.98	$524.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $251.19	Professional		$204.17	$204.17	$251.19
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $691.83 / $1,230.27	Facility		$380.19	$691.83	$1,230.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $831.76 / $1,288.25	Professional		$616.60	$831.76	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $60.26 / $75.86	Professional		$30.20	$60.26	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $213.80 / $436.52	Facility		$204.17	$213.80	$436.52
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $354.81 / $1,047.13	Facility		$354.81	$354.81	$1,047.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $354.81 / $354.81	Professional		$269.15	$354.81	$354.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $131.83	Professional		$125.89	$125.89	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $151.36 / $1,047.13	Professional		$125.89	$151.36	$1,047.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04