Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $70.79 / $165.96	Facility		$70.79	$70.79	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $52.48 / $165.96	Professional		$38.90	$52.48	$165.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $38.90 / $53.70	Professional		$38.90	$38.90	$53.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $134.90 / $295.12	Facility		$53.70	$134.90	$295.12
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $123.03 / $208.93	Professional		$53.70	$123.03	$208.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $79.43 / $87.10	Professional		$64.57	$79.43	$87.10
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $87.10 / $104.71	Facility		$83.18	$87.10	$104.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $104.71	Professional		$87.10	$104.71	$104.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $151.36 / $223.87	Facility		$91.20	$151.36	$223.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $117.49	Professional		$87.10	$87.10	$117.49
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Facility		$102.33	$102.33	$102.33
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $91.20 / $117.49	Professional		$85.11	$91.20	$117.49
United Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $141.25 / $141.25	Facility		$42.66	$141.25	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $81.28	Professional		$39.81	$46.77	$81.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $158.49	Professional		$52.48	$74.13	$158.49