Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $46.77 / $107.15	Facility		$43.65	$46.77	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $42.66 / $50.12	Professional		$41.69	$42.66	$50.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $44.67 / $89.13	Facility		$44.67	$44.67	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $44.67 / $44.67	Professional		$44.67	$44.67	$44.67
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $117.49 / $141.25	Facility		$57.54	$117.49	$141.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $117.49 / $151.36	Professional		$72.44	$117.49	$151.36
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $50.12 / $104.71	Facility		$50.12	$50.12	$104.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Facility		$50.12	$50.12	$50.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Professional		$50.12	$50.12	$50.12
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Facility		$50.12	$50.12	$50.12
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Professional		$50.12	$50.12	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $52.48	Professional		$50.12	$50.12	$52.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $64.57 / $70.79	Professional		$50.12	$64.57	$70.79