Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $537.03 / $1,258.93	Facility		$537.03	$537.03	$1,258.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $467.74 / $707.95	Professional		$354.81	$467.74	$707.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Facility		$549.54	$549.54	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $398.11 / $549.54	Professional		$398.11	$398.11	$549.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $1,202.26 / $2,238.72	Facility		$478.63	$1,202.26	$2,238.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $1,000.00 / $1,778.28	Professional		$478.63	$1,000.00	$1,778.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $549.54 / $660.69	Professional		$75.86	$549.54	$660.69
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $758.58 / $794.33	Facility		$630.96	$758.58	$794.33
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $794.33 / $794.33	Professional		$707.95	$794.33	$794.33
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $1,148.15 / $1,698.24	Facility		$691.83	$1,148.15	$1,698.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $912.01	Professional		$660.69	$660.69	$912.01
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $776.25	Facility		$776.25	$776.25	$776.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $691.83 / $891.25	Professional		$645.65	$691.83	$891.25
United Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $1,258.93 / $1,258.93	Facility		$380.19	$1,258.93	$1,258.93
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $446.68 / $724.44	Professional		$354.81	$446.68	$724.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $691.83 / $1,202.26	Professional		$562.34	$691.83	$1,202.26