Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $1,778.28	Facility		$758.58	$758.58	$1,778.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $501.19 / $977.24	Professional		$380.19	$501.19	$977.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $524.81 / $524.81	Facility		$524.81	$524.81	$524.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $524.81	Professional		$380.19	$380.19	$524.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $1,318.26 / $3,162.28	Facility		$524.81	$1,318.26	$3,162.28
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $1,258.93 / $2,041.74	Professional		$524.81	$1,258.93	$2,041.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $776.25 / $933.25	Professional		$75.86	$776.25	$933.25
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $912.01 / $1,122.02	Facility		$891.25	$912.01	$1,122.02
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,122.02 / $1,122.02	Professional		$912.01	$1,122.02	$1,122.02
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $1,621.81 / $2,398.83	Facility		$977.24	$1,621.81	$2,398.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $933.25 / $1,230.27	Professional		$933.25	$933.25	$1,230.27
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility		$1,096.48	$1,096.48	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $977.24 / $1,258.93	Professional		$912.01	$977.24	$1,258.93
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $1,380.38 / $1,380.38	Facility		$416.87	$1,380.38	$1,380.38
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $478.63 / $794.33	Professional		$389.05	$478.63	$794.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $977.24 / $1,698.24	Professional		$794.33	$977.24	$1,698.24