Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $154.88 / $371.54	Facility		$154.88	$154.88	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $223.87	Professional		$93.33	$128.82	$223.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $134.90 / $134.90	Facility		$134.90	$134.90	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $134.90	Professional		$100.00	$100.00	$134.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $338.84 / $660.69	Facility		$144.54	$338.84	$660.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $295.12 / $524.81	Professional		$144.54	$295.12	$524.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $177.83 / $194.98	Professional		$75.86	$177.83	$194.98
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $181.97 / $218.78 / $229.09	Facility		$181.97	$218.78	$229.09
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $229.09 / $229.09	Professional		$208.93	$229.09	$229.09
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $338.84 / $501.19	Facility		$204.17	$338.84	$501.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $263.03	Professional		$190.55	$190.55	$263.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $223.87 / $223.87 / $223.87	Facility		$223.87	$223.87	$223.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $199.53 / $257.04	Professional		$190.55	$199.53	$257.04
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $354.81 / $354.81	Facility		$107.15	$354.81	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $117.49 / $204.17	Professional		$100.00	$117.49	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $199.53 / $354.81	Professional		$165.96	$199.53	$354.81