Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $1,023.29	Facility		$426.58	$426.58	$1,023.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $302.00 / $562.34	Professional		$223.87	$302.00	$562.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $316.23 / $316.23	Facility		$316.23	$316.23	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $229.09 / $316.23	Professional		$229.09	$229.09	$316.23
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $741.31 / $1,819.70	Facility		$316.23	$741.31	$1,819.70
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $741.31 / $1,230.27	Professional		$316.23	$741.31	$1,230.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $436.52 / $537.03	Professional		$75.86	$436.52	$537.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $512.86 / $645.65	Facility		$489.78	$512.86	$645.65
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $645.65 / $645.65	Professional		$501.19	$645.65	$645.65
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $933.25 / $1,380.38	Facility		$562.34	$933.25	$1,380.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $741.31	Professional		$524.81	$524.81	$741.31
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Facility		$630.96	$630.96	$630.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $549.54 / $724.44	Professional		$524.81	$549.54	$724.44
United Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $812.83 / $812.83	Facility		$245.47	$812.83	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $288.40 / $478.63	Professional		$234.42	$288.40	$478.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $549.54 / $977.24	Professional		$457.09	$549.54	$977.24