Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $37.15 / $89.13	Facility		$37.15	$37.15	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $41.69 / $89.13	Professional		$19.95	$41.69	$89.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $39.81 / $39.81	Facility		$39.81	$39.81	$39.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $48.98	Professional		$33.88	$33.88	$48.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $77.62 / $138.04	Facility		$38.90	$77.62	$138.04
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $85.11 / $141.25	Professional		$39.81	$85.11	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $51.29 / $64.57	Professional		$45.71	$51.29	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $64.57 / $66.07	Facility		$60.26	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $66.07 / $66.07	Professional		$57.54	$66.07	$66.07
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $57.54 / $107.15	Facility		$54.95	$57.54	$107.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $72.44	Professional		$54.95	$54.95	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $57.54 / $74.13	Professional		$54.95	$57.54	$74.13
United Facility/Professional Facility Modifier Low / Median / High Price $0.45 / $25.70 / $30.20	Facility		$0.45	$25.70	$30.20
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $28.18 / $53.70	Professional		$25.70	$28.18	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $57.54 / $102.33	Professional		$47.86	$57.54	$102.33