Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $724.44 / $812.83	Facility		$416.87	$724.44	$812.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $331.13 / $1,000.00	Professional		$245.47	$331.13	$1,000.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $1,445.44 / $2,511.89	Facility		$691.83	$1,445.44	$2,511.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $676.08 / $1,023.29	Professional		$416.87	$676.08	$1,023.29
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $812.83 / $2,344.23	Facility		$501.19	$812.83	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $776.25 / $1,023.29	Professional		$537.03	$776.25	$1,023.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $602.56 / $676.08	Facility		$489.78	$602.56	$676.08
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $363.08	Professional		$363.08	$363.08	$363.08
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $436.52	Facility		$426.58	$426.58	$436.52
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $724.44 / $870.96	Professional		$426.58	$724.44	$870.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,513.56 / $2,951.21	Facility		$1,047.13	$1,513.56	$2,951.21
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $676.08 / $912.01	Professional		$436.52	$676.08	$912.01
United Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,041.74 / $3,715.35	Facility		$1,513.56	$2,041.74	$3,715.35
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $891.25	Professional		$208.93	$316.23	$891.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $416.87 / $588.84	Professional		$354.81	$416.87	$588.84