Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $707.95 / $1,122.02	Facility		$85.11	$707.95	$1,122.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $660.69 / $1,071.52	Professional		$338.84	$660.69	$1,071.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Professional		$812.83	$812.83	$812.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $1,230.27 / $6,606.93	Facility		$128.82	$1,230.27	$6,606.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $1,230.27 / $2,089.30	Professional		$128.82	$1,230.27	$2,089.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Professional		$50.12	$50.12	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $128.82 / $134.90	Facility		$85.11	$128.82	$134.90
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $707.95 / $1,047.13	Facility		$707.95	$707.95	$1,047.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $1,174.90 / $2,290.87	Professional		$223.87	$1,174.90	$2,290.87
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,981.07 / $5,128.61 / $10,000.00	Facility		$3,981.07	$5,128.61	$10,000.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $954.99 / $1,548.82	Professional		$691.83	$954.99	$1,548.82
United Facility/Professional Facility Modifier Low / Median / High Price $5,754.40 / $7,762.47 / $14,125.38	Facility		$5,754.40	$7,762.47	$14,125.38
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $1,071.52 / $1,548.82	Professional		$331.13	$1,071.52	$1,548.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,288.25 / $2,137.96	Professional		$1,122.02	$1,288.25	$2,137.96