Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $81.28 / $194.98	Facility		$81.28	$81.28	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $60.26 / $112.20	Professional		$43.65	$60.26	$112.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $66.07 / $66.07	Facility		$66.07	$66.07	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $47.86 / $66.07	Professional		$47.86	$47.86	$66.07
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $151.36 / $354.81	Facility		$63.10	$151.36	$354.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $147.91 / $245.47	Professional		$63.10	$147.91	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $107.15	Professional		$75.86	$95.50	$107.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $114.82 / $125.89	Facility		$100.00	$114.82	$125.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $125.89 / $125.89	Professional		$112.20	$125.89	$125.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $186.21 / $269.15	Facility		$109.65	$186.21	$269.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $144.54	Professional		$104.71	$104.71	$144.54
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $109.65 / $141.25	Professional		$104.71	$109.65	$141.25
United Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $165.96 / $165.96	Facility		$66.07	$165.96	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $95.50	Professional		$47.86	$67.61	$95.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $89.13 / $190.55	Professional		$61.66	$89.13	$190.55