Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Facility		$69.18	$69.18	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $77.62	Professional		$44.67	$64.57	$77.62
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $162.18 / $275.42	Facility		$38.02	$162.18	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $60.26	Professional		$44.67	$50.12	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $72.44 / $79.43	Facility		$61.66	$72.44	$79.43
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $100.00	Facility		$87.10	$87.10	$100.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $151.36 / $229.09	Professional		$100.00	$151.36	$229.09
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $109.65 / $204.17	Facility		$81.28	$109.65	$204.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $138.04 / $194.98	Professional		$89.13	$138.04	$194.98
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $151.36 / $3,715.35	Facility		$107.15	$151.36	$3,715.35
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $91.20 / $204.17	Professional		$69.18	$91.20	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $107.15 / $151.36	Professional		$91.20	$107.15	$151.36