Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,445.44 / $6,456.54	Facility		$891.25	$1,445.44	$6,456.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $741.31 / $1,698.24	Professional		$467.74	$741.31	$1,698.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $1,905.46 / $2,344.23	Facility		$933.25	$1,905.46	$2,344.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $1,047.13 / $1,288.25	Professional		$478.63	$1,047.13	$1,288.25
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,122.02 / $3,090.30	Facility		$891.25	$1,122.02	$3,090.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,122.02 / $2,454.71	Professional		$891.25	$1,122.02	$2,454.71
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 $891.25 / $891.25 / $1,698.24	Facility		$891.25	$891.25	$1,698.24
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,584.89 / $2,691.53	Facility		$891.25	$1,584.89	$2,691.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,071.52	Professional		$812.83	$812.83	$1,071.52
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $1,348.96 / $2,454.71	Facility		$933.25	$1,348.96	$2,454.71
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $812.83 / $1,000.00	Professional		$758.58	$812.83	$1,000.00
United Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,071.52 / $1,071.52	Facility		$891.25	$1,071.52	$1,071.52
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $1,000.00	Professional		$380.19	$380.19	$1,000.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $1,621.81	Professional		$407.38	$407.38	$1,621.81