Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $1,445.44 / $5,011.87	Facility		$776.25	$1,445.44	$5,011.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $676.08 / $1,513.56	Professional		$426.58	$676.08	$1,513.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $1,621.81 / $1,995.26	Facility		$794.33	$1,621.81	$1,995.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $891.25 / $1,096.48	Professional		$407.38	$891.25	$1,096.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $954.99 / $2,398.83	Facility		$776.25	$954.99	$2,398.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $954.99 / $2,137.96	Professional		$776.25	$954.99	$2,137.96
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 $776.25 / $776.25 / $1,445.44	Facility		$776.25	$776.25	$1,445.44
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $1,348.96 / $2,290.87	Facility		$776.25	$1,348.96	$2,290.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $933.25	Professional		$691.83	$691.83	$933.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $1,148.15 / $2,137.96	Facility		$812.83	$1,148.15	$2,137.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $691.83 / $933.25	Professional		$660.69	$691.83	$933.25
United Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $933.25 / $933.25	Facility		$776.25	$933.25	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $323.59 / $870.96	Professional		$323.59	$323.59	$870.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $776.25 / $1,380.38	Professional		$346.74	$776.25	$1,380.38