Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $66.07 / $158.49	Facility		$66.07	$66.07	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $58.88 / $104.71	Professional		$47.86	$58.88	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $44.67 / $61.66	Professional		$44.67	$44.67	$61.66
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $144.54 / $281.84	Facility		$61.66	$144.54	$281.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $125.89 / $229.09	Professional		$61.66	$125.89	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $75.86 / $83.18	Professional		$67.61	$75.86	$83.18
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $95.50 / $102.33	Facility		$77.62	$95.50	$102.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $97.72 / $102.33	Professional		$93.33	$97.72	$102.33
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $144.54 / $213.80	Facility		$87.10	$144.54	$213.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $97.72	Professional		$81.28	$81.28	$97.72
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Facility		$95.50	$95.50	$95.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $85.11 / $109.65	Professional		$81.28	$85.11	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $162.18 / $162.18	Facility		$48.98	$162.18	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $52.48 / $93.33	Professional		$45.71	$52.48	$93.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $85.11 / $151.36	Professional		$70.79	$85.11	$151.36