Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Facility		$1,288.25	$1,288.25	$1,288.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,258.93 / $1,288.25	Professional		$1,202.26	$1,258.93	$1,288.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $2,570.40	Facility		$1,288.25	$1,288.25	$2,570.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Professional		$1,288.25	$1,288.25	$1,288.25
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $1,737.80 / $2,884.03	Facility		$66.07	$1,737.80	$2,884.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $2,290.87 / $2,884.03	Professional		$1,995.26	$2,290.87	$2,884.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $44.67 / $60.26	Professional		$30.20	$44.67	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $2,137.96 / $2,137.96	Facility		$1,778.28	$2,137.96	$2,137.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,288.25	Facility		$1,258.93	$1,258.93	$1,288.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Professional		$1,288.25	$1,288.25	$1,288.25
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $151.36 / $1,258.93	Professional		$125.89	$151.36	$1,258.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04