Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $575.44 / $2,951.21	Facility		$416.87	$575.44	$2,951.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Professional		$416.87	$416.87	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $851.14 / $1,071.52	Facility		$288.40	$851.14	$1,071.52
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $416.87 / $1,949.84	Facility		$371.54	$416.87	$1,949.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $416.87 / $707.95	Professional		$331.13	$416.87	$707.95
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 $416.87 / $416.87 / $588.84	Facility		$416.87	$416.87	$588.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $724.44 / $1,258.93	Facility		$416.87	$724.44	$1,258.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $371.54 / $501.19	Professional		$371.54	$371.54	$501.19
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $630.96 / $1,096.48	Facility		$436.52	$630.96	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $371.54 / $467.74	Professional		$354.81	$371.54	$467.74
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $501.19 / $501.19	Facility		$416.87	$501.19	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $467.74	Professional		$173.78	$173.78	$467.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $416.87 / $758.58	Professional		$186.21	$416.87	$758.58