Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $229.09	Facility		$95.50	$95.50	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $77.62 / $131.83	Professional		$60.26	$77.62	$131.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $81.28 / $81.28	Facility		$81.28	$81.28	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $81.28	Professional		$60.26	$60.26	$81.28
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $194.98 / $407.38	Facility		$83.18	$194.98	$407.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $169.82 / $302.00	Professional		$83.18	$169.82	$302.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $120.23	Professional		$75.86	$109.65	$120.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $138.04 / $147.91	Facility		$112.20	$138.04	$147.91
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $141.25 / $147.91	Professional		$128.82	$141.25	$147.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $208.93 / $309.03	Facility		$125.89	$208.93	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $154.88	Professional		$117.49	$117.49	$154.88
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Facility		$138.04	$138.04	$138.04
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $123.03 / $158.49	Professional		$117.49	$123.03	$158.49
United Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $213.80 / $213.80	Facility		$64.57	$213.80	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $70.79 / $123.03	Professional		$60.26	$70.79	$123.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $123.03 / $218.78	Professional		$102.33	$123.03	$218.78