Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $2,454.71	Facility		$1,047.13	$1,047.13	$2,454.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $851.14 / $1,412.54	Professional		$660.69	$851.14	$1,412.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility		$1,122.02	$1,122.02	$1,122.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,122.02	Professional		$812.83	$812.83	$1,122.02
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $2,238.72 / $4,466.84	Facility		$933.25	$2,238.72	$4,466.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,995.26 / $3,467.37	Professional		$933.25	$1,995.26	$3,467.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,202.26 / $1,318.26	Professional		$75.86	$1,202.26	$1,318.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,513.56 / $1,621.81	Facility		$1,230.27	$1,513.56	$1,621.81
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,548.82 / $1,621.81	Professional		$1,479.11	$1,548.82	$1,621.81
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $2,290.87 / $3,311.31	Facility		$1,348.96	$2,290.87	$3,311.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,698.24	Professional		$1,288.25	$1,288.25	$1,698.24
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility		$1,513.56	$1,513.56	$1,513.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,348.96 / $1,737.80	Professional		$1,288.25	$1,348.96	$1,737.80
United Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $2,290.87 / $2,290.87	Facility		$707.95	$2,290.87	$2,290.87
United Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $758.58 / $1,348.96	Professional		$660.69	$758.58	$1,348.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,348.96 / $2,398.83	Professional		$1,096.48	$1,348.96	$2,398.83