Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $199.53	Facility		$83.18	$83.18	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $57.54 / $107.15	Professional		$40.74	$57.54	$107.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Facility		$60.26	$60.26	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $43.65 / $60.26	Professional		$43.65	$43.65	$60.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $151.36 / $363.08	Facility		$60.26	$151.36	$363.08
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $144.54 / $234.42	Professional		$60.26	$144.54	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $97.72 / $107.15	Professional		$75.86	$97.72	$107.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $104.71 / $128.82	Facility		$102.33	$104.71	$128.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $128.82 / $128.82	Professional		$104.71	$128.82	$128.82
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $186.21 / $275.42	Facility		$112.20	$186.21	$275.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $107.15 / $141.25	Professional		$107.15	$107.15	$141.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $112.20 / $144.54	Professional		$104.71	$112.20	$144.54
United Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $158.49 / $158.49	Facility		$63.10	$158.49	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $64.57 / $91.20	Professional		$45.71	$64.57	$91.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $194.98	Professional		$91.20	$112.20	$194.98