Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $562.34 / $588.84	Facility		$107.15	$562.34	$588.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $93.33 / $354.81	Professional		$69.18	$93.33	$354.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $125.89	Facility		$117.49	$117.49	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $125.89	Professional		$85.11	$85.11	$125.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $223.87 / $457.09	Facility		$95.50	$223.87	$457.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $194.98 / $346.74	Professional		$95.50	$194.98	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $123.03 / $134.90	Professional		$75.86	$123.03	$134.90
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $151.36 / $158.49	Facility		$125.89	$151.36	$158.49
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $158.49 / $165.96	Professional		$144.54	$158.49	$165.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $234.42 / $338.84	Facility		$138.04	$234.42	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $181.97	Professional		$131.83	$131.83	$181.97
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $154.88 / $154.88	Facility		$154.88	$154.88	$154.88
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $138.04 / $177.83	Professional		$131.83	$138.04	$177.83
United Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $245.47 / $245.47	Facility		$74.13	$245.47	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $81.28 / $144.54	Professional		$70.79	$81.28	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $138.04 / $245.47	Professional		$114.82	$138.04	$245.47