Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $79.43 / $190.55	Facility		$79.43	$79.43	$190.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $70.79 / $104.71	Professional		$51.29	$70.79	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $91.20 / $91.20	Facility		$91.20	$91.20	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $91.20	Professional		$67.61	$67.61	$91.20
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $169.82 / $338.84	Facility		$72.44	$169.82	$338.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $147.91 / $263.03	Professional		$72.44	$147.91	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $91.20 / $100.00	Professional		$75.86	$91.20	$100.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $117.49 / $144.54	Facility		$95.50	$117.49	$144.54
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $120.23 / $144.54	Professional		$107.15	$120.23	$144.54
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $173.78 / $257.04	Facility		$104.71	$173.78	$257.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $131.83	Professional		$100.00	$100.00	$131.83
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $134.90	Professional		$102.33	$102.33	$134.90
United Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $186.21 / $186.21	Facility		$56.23	$186.21	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $61.66 / $109.65	Professional		$52.48	$61.66	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $102.33 / $181.97	Professional		$85.11	$102.33	$181.97