Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $912.01 / $2,137.96	Facility		$912.01	$912.01	$2,137.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $912.01 / $1,412.54	Professional		$53.70	$912.01	$1,412.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Facility		$120.23	$120.23	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $120.23	Professional		$102.33	$102.33	$120.23
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,548.82 / $3,162.28 / $6,760.83	Facility		$1,548.82	$3,162.28	$6,760.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,884.03 / $3,890.45	Professional		$1,548.82	$2,884.03	$3,890.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Professional		$60.26	$60.26	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,621.81 / $1,659.59	Facility		$1,584.89	$1,621.81	$1,659.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,412.54 / $2,344.23 / $3,467.37	Facility		$1,412.54	$2,344.23	$3,467.37
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,621.81	Professional		$1,348.96	$1,348.96	$1,621.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility		$1,584.89	$1,584.89	$1,584.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,380.38 / $1,819.70	Professional		$1,380.38	$1,380.38	$1,819.70
United Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $2,398.83 / $2,398.83	Facility		$109.65	$2,398.83	$2,398.83
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $87.10 / $1,412.54	Professional		$69.18	$87.10	$1,412.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,380.38 / $2,454.71	Professional		$1,148.15	$1,380.38	$2,454.71