Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $338.84	Professional		$112.20	$112.20	$338.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $112.20	Facility		$104.71	$104.71	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $134.90	Professional		$112.20	$112.20	$134.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $630.96 / $912.01	Facility		$380.19	$630.96	$912.01
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $724.44 / $912.01	Professional		$630.96	$724.44	$912.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $50.12 / $60.26	Professional		$39.81	$50.12	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $128.82 / $275.42	Facility		$112.20	$128.82	$275.42
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $389.05	Facility		$194.98	$194.98	$389.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $194.98 / $194.98	Professional		$151.36	$194.98	$194.98
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $131.83	Professional		$125.89	$125.89	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $141.25 / $398.11	Professional		$125.89	$141.25	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04