Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $398.11 / $1,230.27	Facility		$239.88	$398.11	$1,230.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $162.18 / $776.25	Professional		$114.82	$162.18	$776.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $380.19 / $575.44	Facility		$181.97	$380.19	$575.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $194.98 / $263.03	Professional		$107.15	$194.98	$263.03
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $295.12 / $524.81	Facility		$173.78	$295.12	$524.81
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $331.13 / $537.03	Professional		$173.78	$331.13	$537.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $165.96 / $398.11	Professional		$138.04	$165.96	$398.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $173.78 / $331.13	Facility		$173.78	$173.78	$331.13
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $302.00 / $524.81	Facility		$173.78	$302.00	$524.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $154.88 / $208.93	Professional		$154.88	$154.88	$208.93
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $257.04 / $478.63	Facility		$181.97	$257.04	$478.63
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $154.88 / $204.17	Professional		$147.91	$154.88	$204.17
United Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $208.93 / $208.93	Facility		$173.78	$208.93	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $316.23	Professional		$104.71	$144.54	$316.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $173.78 / $309.03	Professional		$77.62	$173.78	$309.03