Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $933.25 / $2,187.76	Facility		$933.25	$933.25	$2,187.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $831.76 / $1,380.38	Professional		$562.34	$831.76	$1,380.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $977.24 / $977.24	Facility		$977.24	$977.24	$977.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $707.95 / $977.24	Professional		$707.95	$707.95	$977.24
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $2,187.76 / $3,890.45	Facility		$912.01	$2,187.76	$3,890.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,778.28 / $3,311.31	Professional		$912.01	$1,778.28	$3,311.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,047.13 / $1,148.15	Professional		$75.86	$1,047.13	$1,148.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,348.96 / $1,819.70	Facility		$1,096.48	$1,348.96	$1,819.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,380.38 / $1,819.70	Professional		$1,230.27	$1,380.38	$1,819.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,995.26 / $2,951.21	Facility		$1,202.26	$1,995.26	$2,951.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,513.56	Professional		$1,148.15	$1,148.15	$1,513.56
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,348.96	Facility		$1,348.96	$1,348.96	$1,348.96
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,548.82	Professional		$1,202.26	$1,202.26	$1,548.82
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $2,238.72 / $2,238.72	Facility		$676.08	$2,238.72	$2,238.72
United Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $724.44 / $1,318.26	Professional		$630.96	$724.44	$1,318.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,202.26 / $2,089.30	Professional		$977.24	$1,202.26	$2,089.30