Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $57.54 / $138.04	Facility		$57.54	$57.54	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $67.61 / $141.25	Professional		$36.31	$67.61	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $45.71 / $87.10	Professional		$45.71	$45.71	$87.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $134.90 / $239.88	Facility		$66.07	$134.90	$239.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $144.54 / $239.88	Professional		$66.07	$144.54	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $104.71	Professional		$32.36	$33.11	$104.71
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $102.33 / $107.15	Facility		$83.18	$102.33	$107.15
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $104.71 / $107.15	Professional		$91.20	$104.71	$107.15
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $91.20 / $165.96	Facility		$85.11	$91.20	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $112.20	Professional		$85.11	$85.11	$112.20
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $89.13 / $117.49	Professional		$85.11	$89.13	$117.49
United Facility/Professional Facility Modifier Low / Median / High Price $0.76 / $47.86 / $74.13	Facility		$0.76	$47.86	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $51.29 / $91.20	Professional		$43.65	$51.29	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $89.13 / $158.49	Professional		$74.13	$89.13	$158.49