Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $22.91 / $112.20 / $251.19	Facility		$22.91	$112.20	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $19.95 / $30.20	Professional		$15.14	$19.95	$30.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $54.95 / $64.57	Facility		$25.70	$54.95	$64.57
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $25.12 / $39.81	Facility		$19.95	$25.12	$39.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $25.12 / $42.66	Professional		$19.95	$25.12	$42.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $27.54 / $43.65	Facility		$22.39	$27.54	$43.65
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $43.65 / $75.86	Facility		$25.12	$43.65	$75.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $22.39 / $30.20	Professional		$22.39	$22.39	$30.20
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $37.15 / $69.18	Facility		$26.30	$37.15	$69.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $22.39 / $28.18	Professional		$21.38	$22.39	$28.18
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $30.20 / $30.20	Facility		$25.12	$30.20	$30.20
United Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $10.47 / $28.18	Professional		$10.47	$10.47	$28.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $25.12 / $44.67	Professional		$11.22	$25.12	$44.67