Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Facility		$457.09	$457.09	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $524.81	Professional		$218.78	$363.08	$524.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $1,096.48 / $1,905.46	Facility		$512.86	$1,096.48	$1,905.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $134.90 / $194.98	Professional		$91.20	$134.90	$194.98
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $165.96 / $1,819.70	Facility		$114.82	$165.96	$1,819.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $194.98	Professional		$112.20	$151.36	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $50.12	Professional		$32.36	$33.11	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $117.49 / $120.23	Facility		$100.00	$117.49	$120.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Facility		$83.18	$83.18	$83.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $138.04 / $173.78	Professional		$83.18	$138.04	$173.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $741.31 / $1,148.15 / $2,238.72	Facility		$741.31	$1,148.15	$2,238.72
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $131.83 / $177.83	Professional		$85.11	$131.83	$177.83
United Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,513.56 / $2,691.53	Facility		$1,122.02	$1,513.56	$2,691.53
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $354.81 / $1,047.13	Professional		$93.33	$354.81	$1,047.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Professional		$407.38	$407.38	$407.38