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 $19.05 / $39.81 / $89.13	Professional		$19.05	$39.81	$89.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $39.81 / $48.98	Facility		$39.81	$39.81	$48.98
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 $38.90 / $85.11 / $141.25	Professional		$38.90	$85.11	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $57.54 / $72.44	Professional		$50.12	$57.54	$72.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $64.57 / $66.07	Facility		$52.48	$64.57	$66.07
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $66.07 / $67.61	Professional		$57.54	$66.07	$67.61
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 $53.70 / $57.54 / $74.13	Professional		$53.70	$57.54	$74.13
United Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $37.15 / $46.77	Facility		$25.70	$37.15	$46.77
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $30.20 / $53.70	Professional		$25.70	$30.20	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $57.54 / $100.00	Professional		$46.77	$57.54	$100.00