Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $912.01 / $2,137.96	Facility		$912.01	$912.01	$2,137.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $724.44 / $1,174.90	Professional		$549.54	$724.44	$1,174.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Facility		$758.58	$758.58	$758.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $758.58	Professional		$549.54	$549.54	$758.58
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $1,778.28 / $3,890.45	Facility		$758.58	$1,778.28	$3,890.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,584.89 / $2,818.38	Professional		$758.58	$1,584.89	$2,818.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $933.25 / $1,148.15	Professional		$75.86	$933.25	$1,148.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $1,318.26 / $1,380.38	Facility		$1,071.52	$1,318.26	$1,380.38
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,348.96 / $1,380.38	Professional		$1,202.26	$1,348.96	$1,380.38
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,995.26 / $2,884.03	Facility		$1,174.90	$1,995.26	$2,884.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,479.11	Professional		$1,122.02	$1,122.02	$1,479.11
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Facility		$1,318.26	$1,318.26	$1,318.26
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,174.90 / $1,513.56	Professional		$1,122.02	$1,174.90	$1,513.56
United Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $1,949.84 / $1,949.84	Facility		$588.84	$1,949.84	$1,949.84
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $645.65 / $1,148.15	Professional		$549.54	$645.65	$1,148.15
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,174.90 / $2,089.30	Professional		$954.99	$1,174.90	$2,089.30