Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $41.69 / $100.00	Facility		$41.69	$41.69	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.88 / $57.54	Professional		$25.70	$33.88	$57.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $38.02 / $38.02	Facility		$38.02	$38.02	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $28.18 / $38.02	Professional		$28.18	$28.18	$38.02
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $85.11 / $177.83	Facility		$36.31	$85.11	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $74.13 / $131.83	Professional		$36.31	$74.13	$131.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $63.10 / $64.57	Professional		$60.26	$63.10	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $61.66 / $64.57	Facility		$50.12	$61.66	$64.57
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $63.10 / $64.57	Professional		$56.23	$63.10	$64.57
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $91.20 / $134.90	Facility		$54.95	$91.20	$134.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $63.10	Professional		$52.48	$52.48	$63.10
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Facility		$61.66	$61.66	$61.66
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $54.95 / $70.79	Professional		$51.29	$54.95	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $93.33 / $93.33	Facility		$28.18	$93.33	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $30.90 / $54.95	Professional		$26.30	$30.90	$54.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $54.95 / $95.50	Professional		$44.67	$54.95	$95.50