Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $645.65 / $1,412.54	Facility		$134.90	$645.65	$1,412.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $114.82 / $169.82	Professional		$93.33	$114.82	$169.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $316.23 / $371.54	Facility		$147.91	$316.23	$371.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $141.25 / $229.09	Facility		$114.82	$141.25	$229.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $141.25 / $239.88	Professional		$114.82	$141.25	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $158.49 / $251.19	Facility		$128.82	$158.49	$251.19
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $251.19 / $426.58	Facility		$141.25	$251.19	$426.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $169.82	Professional		$128.82	$128.82	$169.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $213.80 / $389.05	Facility		$151.36	$213.80	$389.05
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $128.82 / $158.49	Professional		$120.23	$128.82	$158.49
United Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $169.82 / $169.82	Facility		$141.25	$169.82	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $158.49	Professional		$60.26	$60.26	$158.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $141.25 / $257.04	Professional		$64.57	$141.25	$257.04