Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $3,388.44 / $7,585.78	Facility		$707.95	$3,388.44	$7,585.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $602.56 / $912.01	Professional		$457.09	$602.56	$912.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $1,698.24 / $1,949.84	Facility		$794.33	$1,698.24	$1,949.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $758.58 / $1,202.26	Facility		$602.56	$758.58	$1,202.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $758.58 / $1,288.25	Professional		$602.56	$758.58	$1,288.25
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 $758.58 / $758.58 / $1,071.52	Facility		$758.58	$758.58	$1,071.52
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $1,318.26 / $2,290.87	Facility		$758.58	$1,318.26	$2,290.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $912.01	Professional		$691.83	$691.83	$912.01
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $1,148.15 / $1,995.26	Facility		$794.33	$1,148.15	$1,995.26
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $676.08 / $851.14	Professional		$645.65	$676.08	$851.14
United Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $912.01 / $912.01	Facility		$758.58	$912.01	$912.01
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $316.23 / $851.14	Professional		$316.23	$316.23	$851.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $758.58 / $1,380.38	Professional		$338.84	$758.58	$1,380.38