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 $478.63 / $630.96 / $1,202.26	Professional		$478.63	$630.96	$1,202.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $741.31 / $741.31 / $741.31	Facility		$741.31	$741.31	$741.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $537.03 / $741.31	Professional		$537.03	$537.03	$741.31
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $1,621.81 / $3,890.45	Facility		$660.69	$1,621.81	$3,890.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,548.82 / $2,511.89	Professional		$660.69	$1,548.82	$2,511.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $954.99 / $1,148.15	Professional		$75.86	$954.99	$1,148.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,230.27 / $1,380.38	Facility		$1,096.48	$1,230.27	$1,380.38
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,380.38 / $1,380.38	Professional		$1,230.27	$1,380.38	$1,380.38
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 / $1,584.89	Professional		$1,148.15	$1,148.15	$1,584.89
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 $1,122.02 / $1,202.26 / $1,548.82	Professional		$1,122.02	$1,202.26	$1,548.82
United Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $1,698.24 / $1,698.24	Facility		$512.86	$1,698.24	$1,698.24
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $575.44 / $1,000.00	Professional		$478.63	$575.44	$1,000.00
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