Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $33.11 / $79.43	Facility		$33.11	$33.11	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $33.11 / $67.61	Professional		$21.88	$33.11	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $30.90 / $30.90	Professional		$30.90	$30.90	$30.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $81.28 / $128.82	Facility		$35.48	$81.28	$128.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $83.18 / $128.82	Professional		$35.48	$83.18	$128.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $64.57	Professional		$32.36	$33.11	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $93.33 / $102.33	Facility		$47.86	$93.33	$102.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $47.86	Professional		$47.86	$47.86	$47.86
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $39.81 / $39.81	Facility		$39.81	$39.81	$39.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $39.81 / $39.81	Professional		$39.81	$39.81	$39.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $67.61	Professional		$52.48	$52.48	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $25.70 / $48.98	Professional		$19.95	$25.70	$48.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $42.66 / $75.86	Professional		$42.66	$42.66	$75.86