Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $120.23 / $120.23	Facility		$104.71	$120.23	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $120.23	Professional		$81.28	$91.20	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $123.03 / $213.80	Facility		$91.20	$123.03	$213.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $123.03 / $199.53	Professional		$91.20	$123.03	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $204.17 / $208.93	Facility		$144.54	$204.17	$208.93
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $208.93 / $302.00	Professional		$141.25	$208.93	$302.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $177.83 / $263.03	Professional		$134.90	$177.83	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $162.18 / $288.40	Professional		$112.20	$162.18	$288.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $114.82 / $199.53	Professional		$104.71	$114.82	$199.53