Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $52.48 / $125.89	Facility		$52.48	$52.48	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $46.77 / $81.28	Professional		$36.31	$46.77	$81.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $79.43	Facility		$64.57	$64.57	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $79.43	Professional		$47.86	$47.86	$79.43
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $112.20 / $223.87	Facility		$47.86	$112.20	$223.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $97.72 / $173.78	Professional		$47.86	$97.72	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $60.26 / $66.07	Professional		$53.70	$60.26	$66.07
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $75.86 / $77.62	Facility		$61.66	$75.86	$77.62
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $77.62 / $83.18	Professional		$70.79	$77.62	$83.18
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $114.82 / $169.82	Facility		$69.18	$114.82	$169.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $81.28	Professional		$64.57	$64.57	$81.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Facility		$75.86	$75.86	$75.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $67.61 / $87.10	Professional		$64.57	$67.61	$87.10
United Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $123.03 / $123.03	Facility		$37.15	$123.03	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $40.74 / $72.44	Professional		$35.48	$40.74	$72.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $67.61 / $120.23	Professional		$56.23	$67.61	$120.23