Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Facility		$89.13	$89.13	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $64.57 / $89.13	Professional		$52.48	$64.57	$89.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Facility		$134.90	$134.90	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $104.71 / $204.17	Professional		$63.10	$104.71	$204.17
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $109.65 / $169.82	Facility		$64.57	$109.65	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $95.50 / $169.82	Professional		$56.23	$95.50	$169.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $70.79	Professional		$32.36	$33.11	$70.79
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $131.83 / $134.90	Facility		$109.65	$131.83	$134.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $194.98	Professional		$91.20	$138.04	$194.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $123.03 / $162.18	Professional		$93.33	$123.03	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $87.10 / $154.88	Professional		$57.54	$87.10	$154.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62