Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $69.18 / $93.33	Professional		$57.54	$69.18	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $102.33 / $199.53	Professional		$70.79	$102.33	$199.53
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $79.43 / $151.36	Facility		$58.88	$79.43	$151.36
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $74.13 / $134.90	Professional		$56.23	$74.13	$134.90
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 $112.20 / $134.90 / $138.04	Facility		$112.20	$134.90	$138.04
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $128.82 / $194.98	Professional		$81.28	$128.82	$194.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $95.50 / $138.04	Professional		$85.11	$95.50	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $194.98	Professional		$69.18	$104.71	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57