Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $186.21	Facility		$77.62	$77.62	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $69.18 / $117.49	Professional		$53.70	$69.18	$117.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Facility		$75.86	$75.86	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $75.86	Professional		$54.95	$54.95	$75.86
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $181.97 / $331.13	Facility		$77.62	$181.97	$331.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $151.36 / $281.84	Professional		$77.62	$151.36	$281.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $89.13 / $97.72	Professional		$75.86	$89.13	$97.72
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $112.20 / $125.89	Facility		$91.20	$112.20	$125.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $114.82 / $125.89	Professional		$104.71	$114.82	$125.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $169.82 / $251.19	Facility		$102.33	$169.82	$251.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $125.89	Professional		$95.50	$95.50	$125.89
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $100.00 / $128.82	Professional		$95.50	$100.00	$128.82
United Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $190.55 / $190.55	Facility		$57.54	$190.55	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $63.10 / $109.65	Professional		$53.70	$63.10	$109.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $100.00 / $177.83	Professional		$83.18	$100.00	$177.83