Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $52.48 / $123.03	Facility		$52.48	$52.48	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $52.48 / $52.48	Professional		$50.12	$52.48	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $21.38 / $21.38	Professional		$21.38	$21.38	$21.38
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $120.23 / $162.18	Facility		$63.10	$120.23	$162.18
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $120.23 / $162.18	Professional		$63.10	$120.23	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $60.26 / $85.11	Professional		$30.20	$60.26	$85.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $58.88 / $61.66	Facility		$45.71	$58.88	$61.66
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $61.66 / $61.66	Professional		$54.95	$61.66	$61.66
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $91.20 / $128.82	Facility		$70.79	$91.20	$128.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Professional		$54.95	$54.95	$54.95
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $58.88 / $58.88	Facility		$58.88	$58.88	$58.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $69.18	Professional		$53.70	$53.70	$69.18
United Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Facility		$75.86	$75.86	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $35.48 / $58.88	Professional		$23.44	$35.48	$58.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $93.33	Professional		$53.70	$53.70	$93.33