Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $194.98	Facility		$83.18	$83.18	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $93.33 / $199.53	Professional		$43.65	$93.33	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Facility		$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $109.65	Professional		$74.13	$74.13	$109.65
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $173.78 / $302.00	Facility		$87.10	$173.78	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $190.55 / $316.23	Professional		$87.10	$190.55	$316.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $151.36	Professional		$32.36	$33.11	$151.36
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $144.54 / $147.91	Facility		$117.49	$144.54	$147.91
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $147.91 / $147.91	Professional		$128.82	$147.91	$147.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $128.82 / $239.88	Facility		$123.03	$128.82	$239.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $162.18	Professional		$123.03	$123.03	$162.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $125.89 / $165.96	Professional		$120.23	$125.89	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $1.00 / $61.66 / $97.72	Facility		$1.00	$61.66	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $69.18 / $117.49	Professional		$57.54	$69.18	$117.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $125.89 / $223.87	Professional		$104.71	$125.89	$223.87