Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $575.44	Professional		$112.20	$112.20	$575.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $112.20	Facility		$107.15	$107.15	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $138.04	Professional		$112.20	$112.20	$138.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $630.96 / $933.25	Facility		$346.74	$630.96	$933.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $724.44 / $933.25	Professional		$467.74	$724.44	$933.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $50.12 / $75.86	Professional		$30.20	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $128.82 / $316.23	Facility		$112.20	$128.82	$316.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $812.83	Facility		$194.98	$194.98	$812.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $194.98 / $194.98	Professional		$147.91	$194.98	$194.98
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 / $128.82 / $812.83	Professional		$125.89	$128.82	$812.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04