Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Facility		$645.65	$645.65	$645.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $549.54 / $812.83	Professional		$407.38	$549.54	$812.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,513.56 / $1,778.28	Facility		$707.95	$1,513.56	$1,778.28
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $616.60 / $676.08 / $3,162.28	Facility		$616.60	$676.08	$3,162.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $676.08 / $1,148.15	Professional		$549.54	$676.08	$1,148.15
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 $616.60 / $758.58 / $1,202.26	Facility		$616.60	$758.58	$1,202.26
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $1,202.26 / $2,041.74	Facility		$676.08	$1,202.26	$2,041.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $616.60 / $812.83	Professional		$616.60	$616.60	$812.83
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $1,023.29 / $1,862.09	Facility		$724.44	$1,023.29	$1,862.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $616.60 / $758.58	Professional		$575.44	$616.60	$758.58
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $812.83 / $812.83	Facility		$676.08	$812.83	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $758.58	Professional		$288.40	$288.40	$758.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $676.08 / $1,230.27	Professional		$309.03	$676.08	$1,230.27