Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $831.76 / $1,995.26	Facility		$831.76	$831.76	$1,995.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $645.65 / $1,148.15	Professional		$524.81	$645.65	$1,148.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $707.95 / $707.95	Facility		$707.95	$707.95	$707.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $707.95	Professional		$524.81	$524.81	$707.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,698.24 / $3,548.13	Facility		$707.95	$1,698.24	$3,548.13
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,584.89 / $2,630.27	Professional		$707.95	$1,584.89	$2,630.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $954.99 / $1,047.13	Professional		$75.86	$954.99	$1,047.13
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $1,071.52 / $1,230.27	Facility		$977.24	$1,071.52	$1,230.27
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,230.27 / $1,230.27	Professional		$1,071.52	$1,230.27	$1,230.27
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,819.70 / $2,691.53	Facility		$1,096.48	$1,819.70	$2,691.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,445.44	Professional		$1,023.29	$1,023.29	$1,445.44
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,202.26	Facility		$1,202.26	$1,202.26	$1,202.26
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,071.52 / $1,380.38	Professional		$1,023.29	$1,071.52	$1,380.38
United Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $1,778.28 / $1,778.28	Facility		$537.03	$1,778.28	$1,778.28
United Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $575.44 / $1,023.29	Professional		$501.19	$575.44	$1,023.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,071.52 / $1,905.46	Professional		$891.25	$1,071.52	$1,905.46