Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $48.98 / $117.49	Facility		$48.98	$48.98	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $36.31 / $64.57	Professional		$26.92	$36.31	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $44.67 / $44.67	Facility		$44.67	$44.67	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $33.11 / $44.67	Professional		$33.11	$33.11	$44.67
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $91.20 / $218.78	Facility		$38.90	$91.20	$218.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $89.13 / $147.91	Professional		$38.90	$89.13	$147.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $58.88 / $64.57	Professional		$52.48	$58.88	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $72.44 / $75.86	Facility		$60.26	$72.44	$75.86
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $75.86 / $75.86	Professional		$69.18	$75.86	$75.86
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $112.20 / $165.96	Facility		$67.61	$112.20	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $63.10 / $75.86	Professional		$63.10	$63.10	$75.86
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $74.13	Facility		$74.13	$74.13	$74.13
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $66.07 / $85.11	Professional		$63.10	$66.07	$85.11
United Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $100.00 / $100.00	Facility		$37.15	$100.00	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $40.74 / $58.88	Professional		$28.84	$40.74	$58.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $66.07 / $117.49	Professional		$54.95	$66.07	$117.49