Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $512.86 / $1,148.15	Facility		$107.15	$512.86	$1,148.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $93.33 / $138.04	Professional		$67.61	$93.33	$138.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $263.03 / $295.12	Facility		$120.23	$263.03	$295.12
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $114.82 / $181.97	Facility		$91.20	$114.82	$181.97
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $114.82 / $194.98	Professional		$91.20	$114.82	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $125.89 / $199.53	Facility		$102.33	$125.89	$199.53
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $199.53 / $346.74	Facility		$114.82	$199.53	$346.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $138.04	Professional		$102.33	$102.33	$138.04
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $169.82 / $316.23	Facility		$120.23	$169.82	$316.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $102.33 / $128.82	Professional		$97.72	$102.33	$128.82
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $138.04 / $138.04	Facility		$114.82	$138.04	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $128.82	Professional		$47.86	$47.86	$128.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $114.82 / $204.17	Professional		$51.29	$114.82	$204.17