Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Facility		$85.11	$85.11	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $97.72	Professional		$77.62	$77.62	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $74.13 / $77.62	Facility		$74.13	$74.13	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $83.18	Professional		$77.62	$77.62	$83.18
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $239.88 / $588.84	Facility		$154.88	$239.88	$588.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $177.83 / $223.87	Professional		$154.88	$177.83	$223.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $50.12 / $75.86	Professional		$30.20	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $79.43 / $117.49	Facility		$77.62	$79.43	$117.49
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Facility		$89.13	$89.13	$89.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $97.72	Professional		$89.13	$89.13	$97.72
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 $125.89 / $125.89 / $131.83	Professional		$125.89	$125.89	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $125.89 / $125.89	Professional		$77.62	$125.89	$125.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04